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* 1. What is your first and last name?

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* 2. What is your email?

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* 3. What is your phone number?

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* 4. What is your date of birth?

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* 5. What is your address?

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* 6. Please describe your situation in as much detail 

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* 7. What is your payment information? (Cash App, Paypal, & Venmo)

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