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CIRCLE OF CARE PROGRAM FEE SCALE

Family Income

The scale below shows a range of per person fees based on your income level. This fee covers all 10 sessions for one person. Choose the fee that works for you.

30K and Under

$50 - $140

30K to 50K

$150 - $210

50K to 100K

$250 - $350

100K and above

$300 - $400

Example: My daughter and I will be attending groups and our Family Income is 30K-50K. I see the range of payment for 10 sessions per participant is $150-$210. I have decided that I am able to pay the sliding scale fee of $190 for 10 session for one participant in groups. My total amount would be $190 x2 (since there are 2 of us attending, and our Total payment amount would be $380.

Choose your rate based on your income by using the Fee Chart above. Fees are in 10 session bundles per person attending.
Multiply that fee by the number of family members attending.
You can pay the entire amount at once, or you also have the option to pay it in 5 monthly installments (including the first payment you make today). To pay in 5 monthly installments, divide by 5 the entire amount you plan to pay for all sessions and enter that number in Total Payment Amount, then choose Recurring Monthly. Indicate that you want the payment to reoccur for 4 months, and it will give you a confirmation of total amount to be paid in 5 payments.
Please complete the clarifying questions below as well, they are there to help us confirm your choices since this payment platform has some limitations.
After your payment has been completed you will receive an email with the Zoom meeting information.
If you have any questions about this process, please feel free to contact us at circleofcare@ebac.org and we can walk through it together.

Circle of Care Online Payment Form

TOTAL PAYMENT AMOUNT Step 1.recurring payment option yes/no, Step 2. First payment charged to card today(Total Payment Amount), Step 3. Recurring payment amount: $$, Step 4: Frequency: weekly, biweekly, monthly:

I would like my donation to recur:

Yes

Amount you would like to recur:

Frequency of donation:

Number of recurrences:

Date of your final recurring donation:

Open the calendar popup.

Please confirm recurring donation:

Contact Information

Company:

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Email:*

Credit Card Information

Card Types Accepted:
Visa

Credit Card Number:*

Card Security Code:*

Expiration Date:*

Electronic Signature:*

I agree to pay above total amount according to card issuer agreement. Once the transaction has completed successfully, a confirmation receipt will be sent to the email address entered.