CDM TV OnDemand – Order Form – Clear Digital Media

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Required information for your CDM TV OnDemand subscription:

Clinic Name*
Membership/Network/Clinic Group that Referred You*
Clinic Main Phone #*
Clinic Main Address*
Street Address Address Line 2 City State ZIP Code
Website*
Contact Name*
First Last
Contact Direct Phone #*
Contact Email*
Subscription Type*
- Monthly ($59.95)
- Yearly ($708.00)
Showcase(s) Interested In*
Select multiple by holding 'SHIFT' key.
Promo Code
Credit Card #*
Name on Card*
Expiration Date*
MM/YY
Billing Zip Code*
Security Code*
Logo Art File Upload
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