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I verify the bank account # I entered is correct, and authorize you to Debit the account for the Total Order Amount & will pay any NSF charges if I entered my account # incorrectly, or if there are not sufficient funds in the account.
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*
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:
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Residential Address
No Signature Required
Company name
*
:
First name
*
:
Last name
*
:
Address 1
*
:
Address 2:
City
*
:
Province
*
:
--Canada Provinces--
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
--USA States--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
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New Mexico
New York
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North Dakota
Ohio
Oklahoma
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code
*
:
Phone
*
:
Email
*
:
Order Overview
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Delivery Time
Standard 8-10 Business Days(included)
Rush
($25 Charge)
1-5 Business Days
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