Please complete the details below...

Please enable JavaScript in your browser to complete this form.
Name
Address
list names of those who are approved to use your card. If no-one else, please state “NONE”

By entering my name below, I authorise Life Right UK Limited (The Company) to charge my card for any booked appointments or consultations, items or services purchased.  I have read the terms and conditions and accept these.  
I understand The Company will continue to use this card unless I resubmit a different card, after which that will be used for all future purchases and the previous card will be deleted.  I also understand that once details are entered, The Company only have access to the last 4 digits of my card (for identification purposes) and all other information is held securely by our processing bank (Stripe).  

I agree to ensure there are sufficient funds in the account to cover any charge and that I will resubmit this form with new card details should my card be replaced, or any of my details change. 

enter your full name to agree to the terms of use.