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I'd never heard of Spreedly! Thank you for pointing that out: it makes this project just the tiniest bit more likely to replace my day job. :)

Does Paypal still have the restriction that if you use them for credit card processing, you must also offer a Paypal checkout? Offering Appointment Reminder though standard PayPal seems like a giant additional headache.

As a user I love paypal because it is really, really easy to end a subscription and there is nothing, whatsoever, the merchant can do about it.