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First Name *

Last Name *

Street Address *

City *

ZIP Code *

State *

Country *

Credit Card

Payment Method *

Payment Method * New Credit/Debit Card

Cardholder Name *

Card Number *

Expiration Date *

Security Code *

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I authorize Shirtsy - On Demand Tee Printing to automatically charge the payment method listed above on the bill day below.

Select Recurring Payment Date:

Order #22816

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DR ANTHONY LEWIS MARTIN

120 Wyndlam Court
Duluth, GA 30097
US

Shirtsy - On Demand Tee Printing

Payment Pending

Notes

Thank you; we really appreciate your business.

Terms

We do expect payment within 30 days, so please process this invoice within that time.