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BILL TO:
SHIP TO:
Name ____________________________
Name ______________________________
Company _________________________
Company ___________________________
Address __________________________
Address ____________________________
City _____________________________
City _______________________________
State _______________
Zip _________ State
__________________ Zip ________
Phone ___________________________
Phone _____________________________
Fax _____________________________
Fax _______________________________
Email ___________________________
Email ______________________________
ORDER
INFORMATION
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Product #
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Description
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Size
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Color
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Quantity
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Unit Price
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Total
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| *Deduct 5% if order is $250; 10% if
$500 or more |
Subtotal* $___________
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| **Shipping & handling
charge = 10% of subtotal |
Shipping & Handling$___________
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Please allow 3-6 weeks for delivery
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GRAND TOTAL$___________
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