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#ILoveGay Payment Form
First Name
Last Name
E-Mail
CC E-Mail
Address
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Country
Phone
Fax
Cost:
$25 + $5 S/H
Tank Top/Shirt Selection
Tank Top, Black, Size S
Tank Top, Black, Size M
Tank Top, Black, Size L
Tank Top, Black, Size XL
T-Shirt, Black, Size S
T-Shirt, Black, Size M
T-Shirt, Black, Size L
T-Shirt, Black, Size XL
Credit Card Type
Visa
Mastercard
American Express
Credit Card Number
Security Code
Visa/MC: 3-Digit Code found on Back of Card
Amex: 4-Digit Code found on Front of Card
Expiration Date
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2023
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Name on Card