Please enter your updated card information below.

If your account is up to date and you simply entering this information because you have a new card (the old card was stolen, expired, etc) you will not be charged until your regular payment is due.

If you have been suspended due to missed payments this card will be immediately charged for any delinquent payments in order to bring your account up to date.

For example:
If you are one month behind, you will be charged $50.
If you are two months behind you will be charged $100.
If you are three months behind you will be charged $150.
If you are four months behind you will be charged $200.
If you are five months behind you will be charged $250 (this is the max).

If you have any questions you may call the Somatic Arts and Sciences Institute at (209) 777-6305.

Name on Credit Card Name of Doula Applicant Email Phone Number
Billing Address
Billing Address 2 (optional)
Card Type
Card Number
Expiration Month
Expiration Year
CSC Verification Number (What is this?)