Payment

Thank you very much for your business!!  Please fill out the information below and include the order number we have provided.  Feel free to contact us anytime with any questions you may have.

*credit cards are not charged until new item(s) are ready to be shipped*

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Customer Info
*First Name
*Last Name
*Email Address
*Order Number
Projected amount (not including shipping)
Payment Info
*Credit Card Type	Select Master Card Visa Discover American Express
*Credit Card Number
*CID
*Expiration Date	Select Month 0 01-January 0 02-February 0 03-March 0 04-April 0 05-May 0 06-June 0 07-July 0 08-August 0 09-September 10-October 11-November 12-December / Select Year 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034
Billing Address
*Bill Address
Bill Address Line 2
*Bill City
*Bill State
*Bill Zip
Shipping Address (if different than billing address)
Ship Address
Ship Address Line 2
Ship City
Ship State
Ship Zip
Comments
Comments
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