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905-227-5354

To complete your payment, please use a credit card.

CLIENT'S NAME

PAYMENT/BILLING INFORMATION

ACCOUNT NO.

Phone no.

Email

Street Address

City

Street Address Line 2

Postal Code

INVOICE NO.

INVOICE AMOUNT

C$

Thank you for your payment!

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ACCESSIBILITY STATEMENT

clientcare@dailyhomecare.ca

PO Box 20020 Thorold RPO Pine Centre ON L2V5B3

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