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Troy Center For Rehab
49 Marvin Avenue • Troy, NY 12180
Personal Information
Full Name
*
Address
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Phone Number
Email Address
*
Transaction Details
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+ Convenience fee: 3%
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Credit Card Details
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Troy Center For Rehab
49 Marvin Avenue
Troy, NY 12180
Tell: 518-273-6646
[response]
ID #[transid]
[created]
[cardholder]
$ [amount]
[cardtype] [ccnum4]
Authorization Number
[authcode]
AVS Response
[avsresult]
CVV response
[cvcresult]
[otherTransaction]
