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Please enter your purchasing information below. Areas marked with a £££ are required fields.

Amount You Are Donating Suggested Amount Quantity
_____________________________________________ $100
£££ Surname:__________________________________________________
£££ First name:_________________________________________________
£££ Preferred Alias:_____________________________________________
£££ Number of nearest phone box:________________________________
£££ Home address: _______________________________________________________________ _______________________________________________________________
£££ Address of secluded car park where money can be exchanged: _______________________________________________________________ _______________________________________________________________
£££ Next of kin:


£££ 'Would you like to keep using your credit card to keep donating for the next five years? (please tick)
£££ How will we get our money?
American Express []

Donation Special Delivery Service (Wal-Mart Only) []

The Phone Booth In Kingston and 32nd []
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