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Name: _________________________ |
Email: _________________________ |
Company (optional): ______________ |
Address: ______________________ |
City: __________________________ |
State: __________ |
Country: ____________ |
Zip: _________ |
Phone: (___) ____- ______ |
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( ) I am enclosing a check or money order for
$149. Please note that we do not accept checks by fax, so if you are
paying by check or money order you must mail it in to the address
above.
"Please make checks or money orders payable to i-Commerce Solutions." |
( ) I want to charge this purchase to my
Credit Card |