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                   SECURE PAYMENT FORM


 

YOUR INFO:  ALL Fields are Required !

Address your credit card co. has on file for you:
Full Name Street
E-mail City

CREDIT CARD INFO:  ALL Fields are Required !

State

Credit Card

Zip
Name on Card Phone
Card Number    
Expiration Date
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C V V 2 #:    What is a CVV2 Number?
   

ORDERING: 
 

If Payment is for web work Please indicate the following:
1)  Invoice # / Date
2)  Amount you are authorizing to be charged to this credit card.

                    

   


YOUR CREDIT CARD WILL SHOW A CHARGE FROM: EEEEK-NET ASSOCIATION, LLC

   

IMPORTANT NOTE: When you click SEND you will likely see a box like the one to the right - this just means the THANK YOU page you are about to go to is not on the secure server (it doesn't need to be! Only the page that accepts your info needs to be.)

YOUR INFORMATION IS NOT BEING SENT OR AT ANY SECURITY RISK!!  Please just click the YES button to complete the process or your payment will NOT be completed.

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