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00 100. 00 200. 00 OTHER Enter amount US the amount of your donation will be shown only on your receipt CREDIT CARD DONATIONS CREDIT CARD TYPE VISA MASTERCARD AMERICAN EXPRESS CREDIT CARD NO EXPIRATION DATE / SECURITY CODE CREDIT CARD BILLING ADDRESS If different from above Cardholder Signature Please print this page and mail your donation payable to OpusCare of South Florida 7270 NW 12 Street PH 6 Miami Florida 33126 OPUSCARE OF...
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