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Items Price Quantity Total

Items		Price	Quantity	Total
Annual Membership; Special Offer $7.00 / year	$195.00 $7.00	1	$7.00
Subtotal			$7.00

Annual Membership; Special Offer

$7.00 / year

$195.00

$7.00

1

$7.00

Subtotal $7.00

Billing Information

* First Name

* Last Name

Company Name

* Address - Line 1

Address - Line 2

* City

* State

* Zip Code

* Country

* Phone Number

* Email Address

Order Summary

Subtotal $7.00

Order total $7.00

Order Summary
Subtotal	$7.00
Order total	$7.00

Card Information
Credit card
Card type	Card number	Expiration Date	CVC

Card Information

Credit card

Card type

Card number

Expiration Date

CVC

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