Your Name:
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Address 2:
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Forward Address for Email:
Proposed Activities on the Serving Domain or Questions:
   
 Method of Payment:

I am mailing a cheque to the address at the bottom of the page.
Please bill my credit card using the information below.
I will call (705) 749-9225 and supply my credit card info.
   
 Name on Credit Card:
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 Amount: $ Canadian residents include the GST
   
 Cheques payable to:
Kawartha Graphics,
360 George St. N, # 6 Peterborough Square, Peterborough, ON, Canada K9J 7E7
or call: 705-749-9225 or fax: 705-749-9226