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Item No:______________________ Quantity: _____________ Color:______________

Imprint Color: _________________ Date Needed: _____________________________

Item Description: _______________________________________________________

Contact Name: _________________________________________________________

Phone Number: _______________________ Fax: _____________________________

Email Address: _________________________________________________________

NAME (As it appears on card): __________________________ EXP. DATE_______

CREDIT CARD NUMBER : _____________________________________________

BILLING ADDRESS – STREET: _______________________________________________

 CITY: _________________________________ STATE: ________ ZIP:___________

SHIP TO:_____________________________________________________________

SHIPPING ADDRESS – STREET: ________________________________________

 CITY: _________________________________ STATE: ________ ZIP: ___________

AMOUNT TO BE CHARGED TO MY ACCOUNT (USD) $ ___________________________________

    By signing this document below, I authorize Ad Magic to charge my credit card for this order.
    Terms: 50% DEPOSIT charged now and balance will be charged upon shipment.
    I accept all responsibility for this transaction and ensure full payment to Ad Magic.

SIGNATURE _______________________________________ DATE ____________

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