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Your full name:

The name on the card:
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Credit card number:
Card ID (CVV2/CVC2)
There is no CVV2 code on the card
Credit card expiration date:
Credit card billing address:
(the address where you receive this credit card's statements)
Your telephone number:
Is this number: home work cellular
Alternative telephone number (optional):
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Your order number:
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(Optional. If you know the amount of the charge)
Your notes or comments about this payment (i.e. what is it for)


  By signing this form I authorize the company "1st International 8669746453" to debit my credit card the amount of US dollars for the above order.
  The prices for credits are the following:
10 credits - $20
55 credits - $60
100 credits - $100
300 credits - $300
500 credits - $500


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