TERMS & CONDITIONS
MOSHE YEHUDAH WEINER
“AREIVIM USA” PROGRAM REGISTRATION
Fill form below or
Your Last Name
Husband's First Name
Wife’s First Name
Husband’s Date of Birth (DD/MM/YYYY)
Wife’s Date of Birth (DD/MM/YYYY)
Telephone No. #
Cell No. #
Husband feels well, does not have any significant medical issues and has no history or suspicion of significant medical issues.
Wife feels well, does not have any significant medical issues and has no history or suspicion of significant medical issues.
If you have any questions about this provision, please contact our office.
Number of unmarried children less than 35 years old
Our office will contact you for full payment information
I also hereby authorize Areivim USA to charge my account for up to $28 on the above specified date of each month as per terms and conditions. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Areivim USA in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next charge date. If the above noted payment dates falls on a weekend or holiday, I understand that the payments may be executed on the next business day.
By clicking submit, I confirm that I have read and agree to the
Terms and Conditions
of Areivim USA.
ACCEPTANCE TO THE PROGRAM IS CONFIRMED ONLY UPON MEMBER'S RECEIPT OF A WRITTEN CONFIRMATION.
For more information please contact us:
or by phone