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F DEFERRED CREDIT REQUESTED $ PAYMENT OPTION (please check only one) Weekly payment without a security deposit Weekly payment with a security deposit Monthly payment Twice-Monthly payment CIGARETTE DISTRIBUTOR EMAIL ADDRESS (email address of designated person responsible for payment processing) CONTACT TELEPHONE NUMBER ( ) On behalf of the above distributor, the undersigned certifies the following: Cigarette distributor voluntarily and freely elects to make deferred payments for purcha.
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