Registration

Bravo Price Corp.,
2610 E 18th Str,Office #1, Brooklyn, NY 11235
Phone: 1-888-258-0852
Fax:       1-212-695-1304
E-mail: support@davidzoncard.com
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    Logon infomation

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    Password:
    Confirm password:  

    Client information

    First Name:
    Last Name:
    Your Phone Number: - -
    (Phone number where we can reach you during day/evening.)  
    Address 1:  
    Address 2:
    City:  
    State:  
    ZIP:  

    Credit Card Information

    Credit Card Number:
    Expiration Date:
    Credit Card Verification Code:

    Visa/MasterCard        
          

             American Express

    For Visa and MasterCard:
    last 3 digits on the back.

      For American Express:
    4 digits on the front.
    Credit Card BANK Name:  
    (Bank Name - Card Issuer Name. It is located on the front of your Card.)  
    Credit Card BANK Phone: - -
    (Bank Phone number located on the back of your Credit Card.)  

    Billing address
    Billing Phone: - -
    Address 1:  
    Address 2:
    City:  
    State:  
    ZIP:  

    Referral
    Referral linked phone:
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