Payment Amount

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Current balance $18.00

Minimum payment amount $5.00

Other amount $ Minimum payment amount is $5.00.

Billing

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Last Name *

Street Address *

Street Address 2

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Credit Card

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Card Number *

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Invoice 18783

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Notes

Checks paypable to: Cong Khal Milval Serpi
83 Milval Lane Highland Mills New York 10930

Please review your invoice and make payment at your earliest convenience.