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Data Springs Misc Payment Form

This form is used for miscellaneous payments with special arrangements outside the provisions of the Support Agreement or standard product pricing.

Account Information:

First Name:*

Last Name:*

Company Name:

Telephone:

Email:*

Billing Address:

Country:*

Street Line 1:*

Street Line 2:

City:*

State/Region:

Postal Code:*

Payment Information:
*

All payments are in U.S. Dollars. Please enter credit card numbers without hyphens or spaces. Thank you.

Amount to Pay:*

Numeric only please. example: 310.00

Please select your payment method:
PayPal

Comments:

Please indicate what this payment is intended for.

Submit Payment

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