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Text File  |  2004-04-06  |  518 b   |  10 lines
  1. BILLING INFORMATION
  2. Name:____________________________ Company:__________________________
  3. Address:_____________________________________________________________
  4. City:__________________________ State:_____ Zip/Postal code:_____________
  5. Country:_______________________ Phone:_______________________________
  6. Fax:___________________________Email:________________________________
  7. Please charge payment to (name on card):________________________________
  8. VISA/MC. #:___________________________________Exp. date:______________
  9.  
  10.