By submitting this form you acknowledge the following will occur:
Pause Terms
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I understand and agree
Full Name
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Phone
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Email
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Practice Name
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What date would you like to start the pause
(2 day notice required)
Effective Pause Date
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What date will you resume your ads?
(Date given can be tentative)
Effective Resume Date
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Are there any additional details you'd like to share?
Additional Pause Details