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Secure Payment System

Your Email:
Recipient's Email:
Ammount to send $:
First Name:
Last Name:
Card Type (VISA, Mastercard, American Express, Discover,):
Credit Card Number:
Expiration Date (MM/DD/YY):
Card Verification Number:
Address 1:
Address 2(optional):
City:
State:
Zip Code:
Home Telephone:
Comments:
I Agree to charge my credit card through a secure connection. I also agree to be billed by Bank of America the ammount I requested.