$5000 cash give away

Prepay

Please fill out the below form and you will be provided with a receipt on submission. Bring the receipt with you when you pick up your car and you're away.

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*Desired Pick-up time:  
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IMPORTANT:
Please enter the exact amount in dollars and cents, using decimal point - use 75.00 instead of 75
DO NOT include comma separators - use 1075.95 instead of 1,075.95.