Secure 
Online Order Form
Cash Register

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Shop worry free because all credit card transactions are secured by encryption technology. lock

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Customer Information
Please fill out the following section as completely as possible.
Name: First:   Mi:    Last: 
Organization:
Phone #:   Fax #: 
Address:
City: State:  Zip Code: 
Country:
E-mail:

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If ordering to or from a country other than the United States of America, please include country code, city code, and number in the phone number blanks.

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Company Address
Christ-Centered Mall
Research Triangle Park
P.O. Box 110525
Durham, NC 27709-0525

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Payment Information
Cashiers Check or Money Order:
Make cashier's check/cheque or money-order/draft payable to Christ-Centered Mall and mail to the address shown above.
Phone Order:
Call 1-919-484-9180 to arrange payment.
Fax Order:
Fax 1-919-484-0114 to arrange payment.
Credit Card.

     Visa Mastercard American Express Discover

    Visa           Master Card        AMEX       Discover

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Credit Card Information
Cardholder's Name on Card:
Zip Code of Billing Address:
Credit Card Number:
Expiration Date:

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Comments
Please enter any questions you may have regarding this 1-year hotlink.


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