MN Nice (Group)

This membership provides up to 5 individuals with free everything! It includes chat visits, online video visits, in home visits, select prescriptions, same day prescription delivery, and coaching.

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Additional members above 5 people for the annual plan

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Customer Information

First Name *

Last Name *

Email Address *

Phone

Organization

Billing Information

All transactions are secure and encrypted.

First Name on Account *

Last Name on Account *

Card Number *

CVV *

Expiration Month *

Expiration Year *

Billing Address

Address 1 *

Address 2

Billing Country *

Billing City *

Billing State *

Billing ZIP Code *

Additional Information

Member 2 First and Last Name

Member 3 First and Last Name

Member 4 First and Last Name

Member 5 First and Last Name

How did you hear about Nice Healthcare?

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Recurring Fee (every 12 months)	$2,500.00
Today's Total	$2,500.00
then $2,500.00 at first renewal on Apr 19, 2025