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Affiliate Payment

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Affiliate Location

Monthly Affiliate Payment(Required)

10% of monthly revenue

Credit Card

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

Payment Consent

To the best of my knowledge this payment is 10% of our monthly revenue

Total

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Unlock the Power of Gospel-Centered Ministry

Monthly

$99.00 / month

Monthly quantity

Yearly

$990.00 / year

Yearly quantity

Save over 15%

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