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Print it out fax or mail it to us Please DONOT enter credit card information or any account info on this form. Fill out the form completly, print out 2 copies, mail it in along with your check or M.O. ***IMPORTANT***
Address City,State,Zip Phone Fax Special Instructions Comments Enter the quantity in the box to the right of each jug you wish to order. Leave the other boxs empty. Allow 2 weeks shipping after check has been recieved. 2 Tier Jug $15.00
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