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Online Payment # 139

Company Name: Palmer, Brady & Company  | Invoice #: 40704  |  Email Address: [email protected]

Total Amount Authorized to Charge: 216.32

Store Card: No, I will complete the payment page for any future orders.

Name on the card: Hailey Savage

Credit Card Information:

Card:   4154177564260000

Month:        Year:   2023       CVV:   041

Card Billing Address:

138 S Park Sq Ste 203
Fruita, Colorado 81521