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NationalLienLaw.com
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P.O. Box 754
Diablo, California 94528
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Fill out the following information and send or fax this form to the above address or fax number. Allow 10 business days for the refund to show up on your credit card. (Please use back of form if necessary.)
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| Name: |
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| Address1: |
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| Daytime Telephone: |
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| Date of Purchase: |
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Form(s) You Purchased:
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| Credit Card Number: |
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| Credit Card Exp. Date: |
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Detailed Reason for Refund:
(to help provide better service in the future)
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| Have you used this service before? |
Yes No |
Would you use this service again?
(please explain)
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