Pre-Pay for AIDeaf Services

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Name(Required)

Email(Required)

Phone Number(Required)

Date of Request(Required)

Assignment Type(Required)

Total

I agree to the following:(Required)

ALL requests have a 2 hour minimum

48HourNotice(Required)

I agree that I must CANCEL with more than 48 hours notice to receive full refund.

Card Type(Required)

Visa

MasterCard

Discover

Amex

Cardholder's Name(Required)

Credit Card Number(Required)

Exp(Required)

Month

Date(Required)

Year

CVV(Required)

Security Code

Billing Zip(Required)

* Emergency rate is any assignment requested last minute within 48 hours.

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