The Fertility Center of Las Vegas

Credit Card Authorization

  • Credit Card Authorization

  • Please do not include the $ symbol. There must be an amount entered into the form, if no payment is to be made to FCLV, please type in the number 0 into the field above.
  • Please do not include the $ symbol. There must be an amount entered into the form, if no payment is to be made to Ovation Fertility, please type in the number 0 into the field above.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY