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APPLICATION FORM PLEASE PRINT CLEARLY
1. (street address Philippines) ____________________________
2. Name to accept mail in: _____________________
3. Code word or Number for future instructions ______________________________________
4. Name to forward mail to you: (Please note. One personal name & one Company name is acceptable in most cases. See each country as we may be able to arrange mail in unlimited names). _________________________________________________________________
Use "Asia Street Address" as your ordering code.
To pay by Bank wire, Bitcoin, MoneyGram, Skrill or Western Union please proceed to and order at our secure web site order form at https://www.ptshamrock.com/order_bwe.html Your order code is "Asia Street Address."
Thank you for your business.