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| Make all
checks payable to: Unique Multiple Gifts |
| Paid by:
(Please check one) |
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Personal
Check |
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Money
Order |
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Certified
Check |
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Visa, M/C,
Amex, Discover (Please circle card type) |
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Credit
Card#_________________________________ Expiration _____________ |
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Name as
appears on card: ____________________________________________ |
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Signature: ________________________________________________ |
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Thank you for your
business! |