Secure Online Credit Card Transaction Please enter shipping address:

Name:
Address:
City:	State: Zip:
Country:
Phone Number:
Email Address:

Comments, questions, suggestions? Special shipping instructions? We have filled in this sample form. In an actual form the shipping and billing information above would be entered by the user at the time of ordering.

Will your billing address and information be the same as your shipping address and information? Yes     No

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