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Make Checks Payable
To: |
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FOR ANY QUESTIONS OR COMMENTS PLEASE CONTACT US: 1-727-327-1549 |
| Please print, complete and mail or fax this form with payment to the address above. We will process it and send it out to you. If you wish to save shipping charges, we would be happy to call you when your order is complete so that you can pick it up from our store. |
| SHIP TO INFORMATION: |
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Name: |
________________________________________________________ |
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School: |
____________________________ |
Phone: |
__________________ |
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Home Address: |
____________________________________________ |
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City: |
_____________________ |
State: |
___________ |
Zip: |
____________ |
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Home Phone: |
______________________ |
PO#: |
_____________________________ |
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Tax I.D. (if exempt): |
_________________________ | ||
| Qty. | Item # |
Description |
Price Ea. | Ext. Price |
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| PAYMENT INFORMATION: | ||
| DO NOT SEND CASH. Credit cards, checks or money orders in US funds only. Checks must be pre-printed with name address and phone number. | ||
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Payment Type: |
Check is enclosed | |
| Charge this order to ( ) Visa ( ) MasterCard | ||
| Authorized Signature: ____________________________________ | ||
| Expiration Date: ______________________ | ||
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Charge this order to our account. Applies to schools and institutions only. Individuals must include check or charge card number. |
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Yes, please confirm my order via e-mail. My e-mail address is: _____________________________________________ |
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THANK YOU FOR YOUR ORDER. |