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         PURCHASE PRODUCT OR SERVICE


   

PURCHASE DESCRIPTION

 

(REQUIRED!  E.G. 'ADVERTISING', 'SOFTWARE PURCHASE')

NAME

 

CONTACT E-MAIL ADDRESS  

(PLEASE ENSURE YOUR ADDRESS IS ENTERED CORRECTLY!)

CREDIT CARD NUMBER

 

(Please type your credit card number without any spaces or hyphens)

CREDIT CARD CVV NUMBER

 

(What is this? More)

EXPIRY DATE

 

AMOUNT

R

(AMOUNT IS IN RANDS)

 

 

 

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