SUBMIT YOUR ECHECK DETAILS

Please use this 100% Secured & SSL Encrypted form to fill your E-check details and our billing department will send you confirmation as soon as your payment is processed.

I (we) hereby authorize Progressive Health Group on behalf of liferxpharmacy.com and my financial institution to initiate debits to my (our) account, for the amount owed, until informed otherwise. I also declare that all information within this form is accurate and true.

* You will not be charged until we are ready to ship your order.