Account Information
Username: must be at least 6 characters
Email address: must be a valid email address format
Password: 6 characters (at least one uppercase letter and one number)
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Contact Information
First name
Last name
Phone: 999-999-9999 format
Payment Information [Optional - not required]

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Credit Card Type
Enter number with or without dashes.
CVV2 number
Exp Month
Exp Year
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