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FIRST M LAST

123 STREET NAME


CITY, ST 12345
123-321-1122

123456789 98-7654321 1/6/2009 2500.00

Viking Collection Services 2500.00

7500 OFFICE RIDGE CIR., STE. 10

EDEN PRAIRIE MN 5534 CHASE BANK USA, N.A.


ACCOUNT #
CV1234 1234567891234567

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