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Payment Confirmation

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Account Information

First Name

Last Name

Company Name (optional)

Email Address

Phone Number

Address 1

Address 2

City

State

Zip Code

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Payment Summary

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Payment Amount
3% Processing Fee
Payment Total

Payment Method

Card Number

CVV

Exp Month

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Exp Year

My credit card billing name & address is the same as my account name & address.

Credit Card Billing Address

The name and address must match the billing contact for the credit card you entered.

First Name

Last Name

Address 1

Address 2

City

State

Zip Code

All the information in this form is correct. I understand that all sales/deposits are final and there are no refunds/returns. I also waive my right to dispute this/any charge made. I have also read and agree to PREMIER OUTDOOR ENVIRONMENTS, INC. terms and conditions. I agree to the 3% processing fee add to the amount I am paying.

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