Our business is granting wishes, so let's get started...
First Name *

Last Name *

Phone Number *

Email Address *

Please upload an image of the bill you would like for us to pay.  Make sure all of the proper information is visible. 

 **This image will only be seen by us and not made public.

If we are able to grant this wish for you, how will this benefit your current situation? *

Thanks!  Happy Holidays!!
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