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If you are an existing Lifeforce Cryobanks cord blood storage client, you may utilize this convenient and secure online form to pay your annual renewal storage fee or your monthly installment payment. The credit card you enter will remain on file for future annual storage fees.

If you prefer to pay by phone, have your unique Storage number (reference number on invoice) available and call 1-800-869-8608. Please contact our Client Services or Accounting department at the same number if you have questions regarding payment.

* indicates a required field.


Baby's Mother's Information
* Mother's First Name
* Mother's Last Name
* Street Address
* City/State
* Postal Code/ZIP
Country

Credit Card Information
* Amount of Payment $ 
* Name as Appears on Card
* Card Number
* CVV Code

The CVV number is located on your credit card, as shown below:
* Card Expiration
* Billing Phone #
* Billing E-mail
Your Storage # (Invoice)
* Relationship to Mother  Self   Other: 

 My Billing Address is the same as entered above.
* Billing Street Address
* Billing City/State
* Billing Postal Code/ZIP
Billing Country

Authorization

I hereby authorize Lifeforce Cryobank Sciences, Inc. to charge my credit card account in accordance with the plan selected above, and apply said charge towards the payment of the charges I owe Lifeforce Cryobanks. I understand that I will remain responsible for recurring charges and additional late fees should my credit card be cancelled or otherwise made unavailable for payment. Should I cancel this contract for any reason prior to processing the cord blood unit (including voluntary cancellation or inability to collect the blood), Lifeforce Cryobanks will retain a $150 administration fee and any additional shipping fees. The remainder will be returned to the client or paying party.

 I understand that the Credit Card or Debit Card provided will be charged for the flexible pay plan and/or the annual storage fee.
 
 
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