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CREDIT/DEBIT CARD
AUTHORIZATION FORM

I request that Jolie Art LLC charge my credit card for the services required or the charges listed below.

CREDIT CARD INFORMATION

Amount will be charge $: (remember tax will be added when processing)
$299
$450
$500
$750
$850
$1200
$1600
$3500
Other

Cardholder Information as It Appears on Your Account

Date of Purchase
Time of purchase
:
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