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Get Il Reorder C011 2012-2024

H the credit card on hand before shipment. Birth control pills requested by mail are not refundable. Planned Parenthood of Illinois is not responsible for lost, stolen, or damaged orders. Please read this form and sign the bottom. Please print clearly Name ___________________________________________________________ Date of Birth ______/______/______ Last First Address__________________________________________________________________________________________________ Street/Apt City Phone # (__.

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