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PRINT THIS FORM AND MAIL OR FAX IT TO: | |
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Yellow Moon Press |
Fax: (617) 776 - 8246 |
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Please type or print clearly. If shipping address is different than billing, please list in Notes sections. DATE: __________________ DAYTIME PHONE # _______________________________ NAME: ___________________________________________________________________ ADDRESS: ________________________________________________________________ CITY: ___________________________ STATE: ___________ ZIP: _________________ MC/VISA # (Circle One) _______________________________ EXP DATE: ____________ Quant. || Item# || Title _________________________________________ || PRICE || TOTAL _____ || _____ || _____________________________________________ || ______ || ______ _____ || _____ || _____________________________________________ || ______ || ______ _____ || _____ || _____________________________________________ || ______ || ______ _____ || _____ || _____________________________________________ || ______ || ______ _____ || _____ || _____________________________________________ || ______ || ______ _____ || _____ || _____________________________________________ || ______ || ______ _____ || _____ || _____________________________________________ || ______ || ______ _____ || _____ || _____________________________________________ || ______ || ______ NOTES:.......................................... ||____________________SUB-TOTAL || ______ .................................................... ||____(MA residents only) 5% MA TAX || ______ .................................................... ||_____________SHIPPING CHARGE || ______ .................................................... ||_________________________TOTAL || ______ |
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