Labels:text | screenshot | font | number | black and white | receipt | document OCR: VIRTUAL VICTOR ORDER FORM Type Info Before Printing NAME: ADDRESS: CITY: STATE: ZIP: PHONE: COUNTRY: EMAIL: CREDIT CARD NUMBER: EXP. DATE: TYPE OF CARD: SIGNATURE: Send Checks & Money Orders to : NUMBER OF COPIES MISSION CONTROL $ SUB TOTAL 7 OAK PLACE MONTCLAIR, NJ 07042 $ SHIPPING ( OverNight ) $ TAX NJ Residents Add 6% 201 783 3600 201 783 3686 Int1 Orders FAX TOTAL 800 999 7995 Phone Orders CHECK or U.S. Currency MONEY ORDER OVERSEAS CLICK HERE I AM OVER 18 YEARS OF AGE, AND ASKED TO BE SENT PRODUCT OR MAILINGS THAT MAY CONTAIN SEXUALLY EXPLICIT MATERIAL WHICH IS FOR MY PERSONAL USE ONLY. I DECLARE INDER PENALTY OF PERJURY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. BIRTHDATE COUNTY OF STATE OF SIGNATURE (required ). DATE
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