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Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone

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Bingo Hall Name (If applicable)

Bingo Hall Website (If applicable)

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Bingo Hall Facebook site (If applicable)

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What type of bingo hall do you play in or will be playing in?

How many bingo sessions are played weekly at your location?

How many Remote Bingo sessions do you want to play weekly?

Do you have contact information for players who come to your bingo hall?

Is there Internet access in the bingo hall?

Do you have any special requests or requirements?

IMPORTANT NOTICE:
Due to rapidly changing laws and regulations, we cannot be responsible for the legality of the use of the product or service by any particular purchaser. Purchasers should determine for themselves that the use of this product is permitted in their locality.

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