DeCiccoAndSons Edgemont PTA Rebate Card Info Collection
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Card #
(on back of card, starts with 4141, 11 digits total)
First Name
Last Name
PTA / PTSAPhone #E-MailAddressCityStateZipBirthdayE-Mailed Circular?
Would you like to receive our weekly circular via e-mail?
E-Mailed Receipt?
Would you like to receive your receipt digitally via e-mail instead of a paper receipt at checkout (in development, not yet available)
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41418999999PaulDeCicco
Hastings On Hudson
(914) 813-2009paul@deciccos.com21 Center StreetArdsleyNY105021/1/1980YY
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