SPADS - Flea Market Mall - Kiosk (Store) Order Form

Please complete the following, and press the Proceed button to start the Payment process.

9/9/2010SPADS - Flea Market Mall 
5500 So. SIMMS ST., pmb Suite 210, Littleton, CO. 80127
Office: (303) 697-4100 - Fax: (303) 697-4100

Days Description Cost Total
15 Days Flea Market Mall - Lease Payment - Free Trial $ 0.00 $ 0.00

If Renewal:   Enter Kiosk Number:   (leave blank if new account!)

CLIENT INFO:               ( All Fields Are Required - Except Fax )

First NameLast Name
Address
CityStateZip
Country
Day PhoneFax
E-mail

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