Mail Order Form
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CC Type_________
CC#________________________________ Exp. Date___________ Sign_____________________________ *Billing Address if different from Shipping Address _____________________________________________________ _____________________________________________________ |
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Item# |
Description |
Price x |
Quantity |
= Total |
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Mail To: |
Subtotal |
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MD only |
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Shipping & handling |
$ 9.95 |
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Total Cost |
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