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Private Pay Purchase
Please read the instructions and fill out the form below!
Instructions for private pay
Follow the steps below to make your purchase! Once the form is submitted, a Reliable Maternity team member will get back to you within the next business day to complete your order.
![2.png](https://static.wixstatic.com/media/4b5830_f2d81241a7ef4237b216e22a9ae97a4b~mv2.png/v1/crop/x_310,y_310,w_473,h_473/fill/w_263,h_263,al_c,q_85,usm_0.66_1.00_0.01,enc_avif,quality_auto/2.png)
Fill out the form below with your information
![2.png](https://static.wixstatic.com/media/4b5830_f2d81241a7ef4237b216e22a9ae97a4b~mv2.png/v1/crop/x_310,y_310,w_473,h_473/fill/w_263,h_263,al_c,q_85,usm_0.66_1.00_0.01,enc_avif,quality_auto/2.png)
Be sure to include the products you would like to purchase using private pay
![2.png](https://static.wixstatic.com/media/4b5830_f2d81241a7ef4237b216e22a9ae97a4b~mv2.png/v1/crop/x_310,y_310,w_473,h_473/fill/w_263,h_263,al_c,q_85,usm_0.66_1.00_0.01,enc_avif,quality_auto/2.png)
Submit!
Fill out the form
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