Registration Form

Submission of this form confirms your request for payment by credit card. You agree to pay any and all amounts charged by Medsbar USA to your credit card as specified below. In addition, you authorize Medsbar USA to obtain approval from the credit card company listed below.

You authorize Medsbar USA to charge your credit card account as listed.

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I affirm that I am at least 18 years old and legally authorized to use the credit card account and number listed below. In addition, I understand and agree that any charges made to the account listed below are non-refundable and agree to pay in accordance with my agreement with the specified credit card and such amounts charged by me both in the past and henceforth.

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Furthermore, I agree to hold Medsbar USA completely and fully harmless from and against all claims of any type or nature whatsoever resulting from any charges made to said account and payments will be charged to the credit card depicted below. Compounded medications will be charged in advance of preparation.