PLEASE TYPE EVERYTHING IN CAPITAL LETTERS.

SHIPPING ADDRESS: FIRST NAME, LAST NAME, ADDRESS, CITY, STATE, AND ZIP CODE:


ID INFORMATION

State:

FIRST NAME:

MIDDLE NAME [OPTIONAL]:

LAST NAME:

ADDRESS:

CITY:

ZIP CODE:

EYE COLOR:

HAIR COLOR:

HEIGHT:

WEIGHT:

DOB [ON THE CARD]:

SEX:

LINK TO ID PICTURE [IMGUR.COM]:

LINK TO SIGNATURE IMAGE [IMGUR.COM] :

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WHAT I NEED FOR PAYMENT VERIFICATION

YOUR BITCOIN ADDRESS/LITECOIN ADDRESS/AMAZON GIFTCARD CODE:

AMOUNT OF BITCOINS/LITECOINS/AMAZON SENT:

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