Please print this form and mail it in with your payment 

 

 

 

  Checks must be payable to:
JOSE ANTONIO TOLEDO 
5938 Joaquin St
Chino, CA  91710
  Address on the left fits in a
regular size window envelope.
 
 
 
 

 

 

 

Check Number:           Check  Amount: 
 

 

 

 

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