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Credit card You can pay by credit card. Credit card owner Credit card number Expiration date / Card validation code

Name	Unit price	Quantity	Total price
Permanent Bladder and Bowel Incontinence	$30.00	1	$30.00
Bladder Trainer - Ocean	$35.00	1	$35.00
Binky Dual Layer	$35.00	1	$35.00
		Total	$100.00

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