1 Step 1
LIFT 24/7
First Name
Last Name
Address
Phone Number
City
State / Province / Region
Postal / Zip Code
Country
Credit card number
Expiration Date
date_range
Amount in PHP
Utilities Payment
Additional Notes:
Lift Fee
Payment
Subtotal: [field27]
Lift Fee: [field30]
Amount Due in PHP: [field27 + field30]

Note: All peso charges shall be billed in USD which will show on your statement. 

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FormCraft - WordPress form builder
1 Step 1
LIFT 24/7
First Name
Last Name
Address
Phone Number
City
State / Province / Region
Postal / Zip Code
Country
Credit card number
Expiration Date
date_range
Amount in USD
Utilities Payment
Additional Notes:
Payment
 Subtotal: [field62]
Lift Fee: [field54 / 53.42]
Amount Due in USD: [field62 + field55]

Lift Fee: [field48 / 53.42]
Amount Due in USD: [field62 + field60]

Note: All peso charges shall be billed in USD which will show on your statement. 

Field48(hidden):

[field52]

Field52(hidden):

[field62 * 53.42]

Field55(hidden):

[field54 / 53.42]

Field54(hidden)
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FormCraft - WordPress form builder