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~ <br /> ~~Q <br /> 524 BOGRRT LgNE h ~ ~e~`~~~~p2 <br /> _ ~ ' <br /> e <br /> o <br /> CUSTOMER'S ORDER NO. DEPT. <br /> - ~s NAME: ~ <br /> ''j <br /> " ADDRESS: <br /> CITY, STATE, ZIP k, <br /> _ <br /> SOtD BY• <br /> t CASH C.O.D. CHARGE ON ACCT. MDSERTD. PAID OUT <br /> '`~UA'NTII 5 <br /> t - ~(RIPT,ION PRICE A~tOUN-T <br /> 1 /r1 <br /> ~~.h ~ ~,5 <br /> : <br /> ~ <br /> e <br /> ~ <br /> 5 ~ ~ S <br /> . ~ <br /> ~ a ~A` <br /> ~ it _ ~ ~ <br /> - <br /> RECV <br /> <br /> - . - ,y <br /> ~ <br /> 1:: a. <br /> ~ ~ .a <br /> RECEI~EU.BY <br /> L:+ <br /> ' KEEP THIS COPY FOR YOUR RECORDS <br /> _ ©2001 REdFORMo 5L320 <br /> C''~ <br /> ~ ' <br /> <br />