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Order Request!
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Full Name *
Email address *
Phone number *
Birthday *
MM
/
DD
/
YYYY
Shipping Address *
Card number *
Exp date *
CVS #  (3 digit security number on the back of card) *
Billing Address (if shipping & billing are the same, please type "same".) *
Date you want order processed *
MM
/
DD
/
YYYY
Would you like to be a part of my Monthly Cash Giveaway Text Club? *
E-sign by typing your name below to confirm the information is correct and to authorize the transaction on the date specified above! Thank you! *
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