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YOUR LISTING INFORMATION

First Name  
Last Name
Business Name  
City
State   Zip  Phone

Email Fax

Comments

CREDIT CARD INFORMATION

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  Card Number   
  Ex Date

  Name on card

    
          

OTHER Payment Options:

POSTAL SERVICE: Simply print this form and MAIL with your personal check for $60 to: Heritage Press, W987 Cedar Valley Rd, Stoddard, WI  54658.

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