Secure Credit card payment form

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Credit card billing information
Full name appearing on credit card:
billing Street Address:
billing City:
billing State:
billing Country:
billing Postal code/ zipcode:
Card Number:
(1111222233334444)
Expiration:
CVV2:
(rightmost 3 digits on back/ amex 4 on front)
Email used in personal ad:
Ad number:
(if known)

Add the two numbers: + = (required to stop form spam)

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