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Email Address
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First NameInitialLast Name
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Address
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CityStateZip
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Daytime Phone[  ] Home[  ] Business 		  SHIP TO (only if different)

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First NameInitialLast Name
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Address
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CityStateZip
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Daytime Phone[  ] Home[  ] Business 		 
 
  Item   Catalog Number Size How Many Price for One
(Pkg., Ea., ect.)		 Total Price
           
           
           
           
           
           
           
           
           
           
rev 7-22-03


For CREDIT CARD Order: Complete this section:
Check one box, enter account number, sign below:

[  ] Visa   [  ] MasterCard    [  ] American Express

|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

Expiration Date: Month/Year  |   |   |   |

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Signature (Required for charge orders.)       Date		 MERCHANDISE TOTAL$
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AMOUNT FOR SHIPPING & HANDLING  $
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SALES TAXES (GA Residents add 7%) $
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TOTAL PAYMENT$
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Please pay by check or money order in U.S. dollars.
Sorry, we do not accept C.O.D. orders.
Do not send currency or stamps