Redeem Gift - VIP Pelvic Pain Relief

[MM_Form type=’checkout’] [MM_Form_Message type=’error’]

[MM_Form_Section type=’accountInfo’]

Account Information

First Name:
[MM_Form_Field type=’input’ name=’firstName’ customAttributes=’placeholder=”First Name”‘]

Last Name:
[MM_Form_Field type=’input’ name=’lastName’ customAttributes=’placeholder=”Last Name”‘]

Email:
[MM_Form_Field type=’input’ name=’email’ customAttributes=’placeholder=”Email Address”‘]

Password:
[MM_Form_Field type=’input’ name=’password’ customAttributes=’placeholder=”Password”‘]

Phone:
[MM_Form_Field type=’input’ name=’phone’ isRequired=’false’ customAttributes=’placeholder=”Phone Number”‘]

[/MM_Form_Section]

[MM_Form_Section type=’coupon’]

Gift Code

[MM_Form_Field name=’couponCode’] Apply Gift Code

[MM_Form_Message type=’couponSuccess’] [MM_Form_Message type=’couponError’]

[/MM_Form_Section]

[MM_Form_Data name=’productName’]

[MM_Form_Data name=’productDescription’]

[MM_Order_Decision isDiscounted=’true’] Redeem Gift
[/MM_Order_Decision] [MM_Order_Decision isDiscounted=’false’] Enter a valid gift code to redeem your gift
[/MM_Order_Decision]

[MM_Form_Field type=’hidden’ name=’phone’] [MM_Form_Field type=’hidden’ name=’billingAddress’] [MM_Form_Field type=’hidden’ name=’billingCity’] [MM_Form_Field type=’hidden’ name=’billingState’] [MM_Form_Field type=’hidden’ name=’billingZipCode’] [MM_Form_Field type=’hidden’ name=’billingCountry’] [MM_Form_Field type=’hidden’ name=’shippingAddress’] [MM_Form_Field type=’hidden’ name=’shippingCity’] [MM_Form_Field type=’hidden’ name=’shippingState’] [MM_Form_Field type=’hidden’ name=’shippingZipCode’] [MM_Form_Field type=’hidden’ name=’shippingCountry’] [/MM_Form]