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Fill first name with “Tom”.

Fill last name with “Hall”.

Fill address 1 with “4114 Sepulveda Blvd”.

Fill City with “Culver City”.

Fill zip code with “90230”.

Select State or province “California”

Select country “United States”.

Fill phone number “1234567890”

Fill Card number with “4024007148673576”

Select the year “2014”

Fill Cvv with “123”