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Make Checks Payable To:
AMI
Film Bin
Method
Of Payment:
____Visa________
__MasterCard__ __Discover__
__Am Ex
____Money
Order_ __Check
______ __C.O.D. (add $5.00)
__________________________________________________________
CREDIT
CARD NUMBER_________________________________EXP.DATE
(MO/YR)
__________________________________________________________
CUSTOMER
SIGNATURE
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