Full Name:________________________________________________________ Address 1:________________________________________________________
Address 2:_________________________________________________________ City/Town:_________________________ State/Province__________ Zip/Postal Code____________
Item(s) you are ordering:______________________________________________________________ Total cost of item(s) ordered:______________________________
New York State Residents Sales Tax (Total cost x 1.07)________________________ International Buyers (please add shipping amount specified on product page):____________
TOTAL DUE (Add total cost of items + Tax & International shipping if applicable):_____________ Phone number or e-mail for contact (REQUIRED if ordering by mail)
_______________________
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