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Type of Credit Card  
Amount To Be Charged
   $
Your eMail Address  
Cardholder's Name
(as it appears on the card)		  
Credit Card Number  
Credit Card Expiration Date   / (month/year)
Cardholder's street address
  
Cardholder's City  
Cardholder's State/Province  
Cardholder's zip/postal code  
Cardholder's Country  
Telephone Number  
Card verification number (CVV2)  

Usually last 3 digits in the back of the card.

*Required if entering Credit Card info, and

the number is present on your card