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School: __________________________________ Name: ___________________________________ Phone: ________________Address: _______________________________________ Apt# ____________City: ________________________ State:_____________ Zip:_____________Email: __________________________________________________________
Visa Master Card Discover Check
Credit Card Number: ___________________________ Expiration: __________Security Code: _______________
Quantity: __________ Amount Enclosed: $_________
(MAKE CHECK PAYABLE TO: CEVA MEDIA GROUP)