ONLINE PAYMENT PROCESSING FORM

NOTE: YOU WILL BE BILLED AS "J/R SPORTS PICK CO."

BUY DAILY DGP FOR $10.00 (REFUNDABLE)

WE ACCEPT VISA & MASTERECARD

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CUSTOMER INFORMATION

NAME
ADDRESS
CITY
STATE
ZIP
COUNTRY
E-MAIL

IMPORTANT NOTICE: PLEASE AVOID " # ", " . ", " - " IN YOUR FORM.