Please ship items listed below to:
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Name:_____________________________
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Phone/FAX:_____________
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Organization:
__________________________________________________
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Address:
______________________________________________________
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City/State/Zip:
_________________________________________________
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Order Number |
Qty |
Price per Item |
Total Price |
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| Subtotal |
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| Shipping |
$4.85 |
| *
Tax |
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| TOTAL |
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Please
allow 1 week for delivery.
International Orders Accepted
* Mississippi residents add 7% sales tax.
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Account # :
________________________________________
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Signature :
________________________________________
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Printed Name on Card :
______________________________
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