Email address

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First name

Last name

Street address

Street address 2

Country

State

Zip Code

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2

Flat Rate

Fixed $0.00

Flat Rate

Fixed $0.00

3

Credit card Cash on Delivery

Name on card

Full name as displayed on card

Credit card number

Expiration

CVV

4

$29.89

Order subtotal $89.67

Shipping $11.00

Tax $0

Total $100.67

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