Payment Sheet

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Client Name

First

Last

Email

Type of Package Purchased

Address

Address Line 1

Address Line 2

City

State

Zip Code

Mobile

Phone

Type of Card

Card Number

Expiry Date

Security Code

Name on Card

Select System

LIMITED EDITION ULTIMA PREMIUM - $ 8,997.00
The Refund Specialist System (International Edition) - $ 5,997.00
The Refund Specialist System (Australian Edition) - $ 4,997.00