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Billing Address

First Name*

Last Name*

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Company Name

Address*

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Town/City*

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Ship to Different Address

Shipping Address

First Name*

Last Name*

Email Address*

Phone no*

Company Name

Address*

Country*

Town/City*

State*

Zip Code*

Cart Total

Product	Total
pixer photo Original x 1	$110.00
Medium Roast Ground pixer x 1	$19.00
Sub Total	$129.00
Shipping Fee	$5.00
Grand Total	$139.00

Payment Method

Check Payment

Please send a Check to Store name with Store Street, Store Town, Store State, Store Postcode, Store Country.

Direct Bank Transfer

Please send a Check to Store name with Store Street, Store Town, Store State, Store Postcode, Store Country.

Cash on Delivery

Please send a Check to Store name with Store Street, Store Town, Store State, Store Postcode, Store Country.

Card Payment

Please send a Check to Store name with Store Street, Store Town, Store State, Store Postcode, Store Country.

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