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Check one. m Check Please make check payable to Shoff Darby Companies Inc. Enclosed is check for m Credit Card If you are making your payment by credit/debit card please complete the following m VISA m MASTERCARD m AMERICAN EXPRESS Card number CSC card security code Expiration date I authorize Shoff Darby Companies Inc. to charge my payment to my credit card in the amount of Print name as on card Address of cardholder Cardholder signature GENERAL FRAUD STATEMENT Applicable in AL AR DC LA MD...

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