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Shipping and Billing Form

1

Personal Information

FIRST NAME

LAST NAME

MOBILE NUMBER

EMAIL

2

Billing Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

3

Shipping Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

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Total	₹ 490.00
Sub Total	₹ 441.00
Discount	₹ 35
Estimated Tax	₹ 35
Shipping Charge	Free
Gift Wrap	₹ 35
Payble Amount	₹ 405

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