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*Quote/Invoice Number:   
*Amount: $
Company Name:   
*Contact Name:   
*Name as on Credit Card:   
*Credit Card Number:   
*CVV Code:   
*Expiration Date:    \ 20
*Billing Address 1:   
Address 2:   
Disclaimer: Once payment has been processed, and hardware / software / service provided, or scheduled, or progress work begun, customer has then received product and payment is not refundable.

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Computer SOS Inc. • 1505 Cleveland Drive • Buffalo • New York • 14225
Phone: 716.635.0086 • Toll Free: 866.306.2767

2013 Computer SOS Inc. • All rights reserved