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Police Agencies Credit Card Authorization Form
Last Name
*
First Name
*
Police Department
*
Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Email Address
*
Credit Card Number
*
Expiration
*
Security Number
*
Special Instructions
*
Signature
Initial authorizing Dynasty Cleaners/Peninsula Cleaning Services to charge the above credit card for laundry and dry cleaning services rendered.
*
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