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Please provide the information of the new member we’re adding to your account.

New Member 1

New Member Information

Where should we send the testing kit to?

Shipping address is the same as mine.

Shipping Address

First Name

Last Name

Email Address

Street Address

First Name

City

First Name

Last Name

New Member 2

New Member Information

First Name

Last Name

Email Address

Where should we send the testing kit to?

Shipping address is the same as mine.

Shipping Address

First Name

Last Name

Email Address

Street Address

First Name

City

First Name

Last Name

Payment Method

Use the card on file with my account.

Pay with Credit Card

Card number

Expiration Date

Card Security Code

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We protect your payment information using encryption to provide bank-level security.

Billing Summary

Subtotal $3720,27

1 AliRx Test kit $499.99

AliRx Membership $49

Shipping $0.00

Tax $228.72

Grand Total $3,439.00

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