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Episcopal Cursillo Ministry Shipping Account Form
Please submit this form for use by ECM
to cover additional shipping charges for orders shipped outside the continental U.S.
Name on credit card
Credit Card Number
Exp. Date, i.e. ##/##
Security Code
Billing Address
City
State/Province
State/Province
Country
Postal Code
Is your shipping address the same as your billing address?
Yes
No
Shipping Address if different from your billing address above
City
State/Province
Country
Postal Code
Phone, i.e. ###-###-####
E-Mail
Diocese
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