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First Name:  
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confirm email:  
CREDIT CARD INFORMATION
Name on Credit Card:
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This document will not be "signed" in the sense of a traditional paper document. To verify the contents of this form, the signatory must enter any combination of alpha/numeric characters that has been specifically adopted to serve the function of their legal signature.

Pursuant to the Federal Electronic Signatures in Global and National Commerce Act and applicable state laws, I consent to Pioneer Basement's use and reliance on my electronic signature to verify the information that I have provided herein.



Signature: Date: 08/21/2008






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