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Customer Information

Customer Name: Date of Application: 01-01-1970
Phone: Email:
Purchase IP Address: Authorization IP Address:
Billing Address:
Shipping Address:

Credit Card Information

Name on Card: Card Type: -
Card Number: XXXX-XXXX-XXXX- Exp Date: -

I, , hereby authorize Satmodo, LLC (Satmodo), via this signed authorization, to charge the above credit card for the amount of $ for all products and services I purchased and requested.

As the credit card holder, I hereby authorize receipt of goods & services at the shipping address listed above.

 I agree to all the terms and conditions of Satmodo.


Digital Signature of Card Holder ( )
You are confirming from this IP address: 3.235.107.209

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