Credit Card Form
3%  charge with each transaction. 

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WE ARE NOW ACCEPTING PAYMENTS OVER THE PHONE!!
(as of 3-25-2020)

This form can be sent multiple ways:

Mail: PO Box 157, Eagle Point ,OR

Email: epidist@centurylink.net

Fax: 541-826-8738

Do you have a smart phone?
​If so ,you can fill out the form and send a picture  to our email : ​epidist@centurylink.net

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