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For any credit transactions please fill out the following Credit/Debit Card Type VISA MASTERCARD Card Number 3 digit code Exp. Date I authorize Garth Newel Music Center to charge this card for Down Payment or payment in full upon receipt Amount Auto-Debit Monthly Payments on the 5th day monthly October 2017 through end of term Signature Date OFFICE USE PAYMENTS RECEIVED Amount Monthly on Date Received Oct Nov Dec Jan Feb Mar April May Optional Summer June EMERGENCY MEDICAL CARE FORM...
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