ORDER
FORM
SHIP TO:
Name________________________________________________
Address________________________________________________
City________________________State______Zip
Code__________
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Total Cost |
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TOTAL AMOUNT OF ORDER |
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SALES TAX (If Applicable) |
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Add Postage (see chart) |
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C.O.D. – Add $5.00 |
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TOTAL AMOUNT ENCLOSED |
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MAIL COMPLETED FORM TO:
POLKADOLL.COM
10
MOUNTAIN VIEW STREET
SOUTH
HADLEY, MASSACHUSETTS 01075