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By selecting this check box, I authorize Coffy Group - ProfitEngines to initiate a one-time/recurring charge to the bank account I’ve designated reflected in the account information listed above, as of the date displayed below. I agree that ACH transactions I authorize comply with applicable law. To complete the payment process, click the “Complete Order” button. I understand that once payment is authorized, there cannot be any changes or corrections.

Client acknowledges that it has received, read, understands and agrees to be bound by the terms of this Order Form, which terms are governed by PracticeBloom's Terms of Service, including without limitation, Dispute Resolution section of the Terms of Service. First month payment is a setup fee and is non-refundable. PracticeBloom's Terms of Service are available here: https://1499.profitengines.com/terms Upon expiration of the Contract Term, Client’s service will automatically renew unless it provides PracticeBloom with notice of non-renewal in accordance with the Termination/Cancellation section of the Terms of Service.

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Payment Summary

Description	Cost
Subtotal	0
One Time Fee	0
Non-cash adjustment 3.85%	0
Billed Today	0
Charged Today	0

Status:

Date of purchase is 10/28/2025