Signup and payment form Payment Form FHA Financial Health Assessment SINGLE (2 hours @ $195) - By choosing this option, you acknowledge that you are unmarried and will be alone for your Financial Health Assessment and that you abide by the Terms of Service MARRIED (2 hours @ $295) - by choosing this option, you acknowledge that you are married and that you will both attend the Financial Health Assessment and that you will abide by the Terms of Service Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* I understand there are no refunds and no reschedules* I understand that I will complete and submit all pre-assessment work at least 48 hours before my appointment and that failure to do so will result in the appointment being canceled. I understand there are no refunds and no reschedules* By scheduling, I agree to the terms of service. Please read those here: Payment Method* Debit Card ACH/eCheck We recognize that the Visa and MasterCard monopoly on the debit card industries prohibits merchants from only taking debit cards. For that reason, it’s impossible for us to ensure that every transaction complies with our card payment policy. While debit cards are acceptable, our policy is to always discourage our clients from using credit cards in the payment of our services. We accept your card payment in good faith that you will honor our policy. Thank you!Debit Card*Card Details Cardholder Name