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  Credit card submission

All fields must be completed.
Order Information
Name
Email Address
Phone Number
Order Number
Order Amount
Credit Card Information
Cardholder’s Name
(If different from Name field above)
Credit Card Number
Expiration Date
CVV Code
Billing Address (as specified on your credit card statement)
Address Line 1
Address Line 2

(optional)
City
State/Province/Region
Zip/Postal Code
Country
 
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