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First Name
Last Name
Age
Telephone
Country
US +1
MX +52
NA +
E-mail
God you live or work in the United Sates
Yes
No
State
Choose your State
Aguascalientes
Baja California
Baja California Sur
Campeche
Chiapas
Chihuahua
Coahuila
Colima
Ciudad de México
Durango
Guanajuato
Guerrero
Hidalgo
Jalisco
México
Michoacán
Morelos
Nayarit
Nuevo León
Oaxaca
Puebla
Querétaro
Quintana Roo
San Luis Potosí
Sinaloa
Sonora
Tabasco
Tamaulipas
Tlaxcala
Veracruz
Yucatán
Zacatecas
Otro, lo indicaré en el campo ciudad
City
Do you have a relative in the USA from whom you receive money transfers?
Yes
No
Do you have a question??
Promocode from friend
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