CheckMate

CheckMate Counseling Application & Payment Form

Name*
First Last
Email*
Enter Email Confirm Email
Reason why you visited the website today?*
Preferred Duration of Relationship Services?*
Important Note: There will be one (1) counseling session per week. Each session will last 1.5hrs and will cost $75.00. A $2.55 charge will be added to cover electronic payment processing fees (if applicable). This fee will be due no later than the day before the scheduled onsite and/or video counseling session. We will be in touch with you shortly to schedule your first session.
Payment For Scheduled CheckMate Counseling Session*
Price: $77.55 Quantity:
Important Reminder: There will be one (1) counseling session per week. Each session will last 1.5hrs and will cost $75.00. A $2.55 has been added for electronic processing fees. This fee will be due no later than the day before the scheduled onsite and/or video counseling session.

If you prefer to avoid the electronic processing fee, please mail your check or money order to the following address:

Mail your check/money order to:
Shirley McKenzie
P.O. Box 753
Millington, TN 38083
Please make checks payable to: Shirley McKenzie
Address (Onsite Visitation)*
Street Address Address Line 2 City State ZIP Code
CheckMate Lesson Guide (Couples' Packet)*
Price: $52.50 Quantity:
Important Note: The Couples' Packet includes two (2) CheckMate Lesson Guides. A $2.50 charge has been added to cover electronic payment processing fees.

If you prefer to avoid the electronic processing fee, please mail your check or money order to the following address:

Mail your check/money order to:
Shirley McKenzie
P.O. Box 753
Millington, TN 38083
Please make checks payable to: Shirley McKenzie