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PLEASE TYPE IN YOUR ORDER, PRINT AND FAX TO: 1-386-668-4344 |
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Item |
Qty |
Description |
Amount |
bsf1 |
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1 Baby Safe Feeder |
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bsf2 |
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4 Replacement Bags |
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bsf3 |
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2+2 Starter Kit(2 Feeders + 2 Bags) |
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Subtotal |
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| (Florida Residents please add sales tax) | |||
Shipping and Handling Shipping and handling rates for domestic orders only |
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Total |
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CARDHOLDER INFORMATION: |
SHIP TO ADDRESS:
(ONLY IF DIFFERENT FROM BILLING ADDRESS) |
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Address:
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Address:
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City:
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City:
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State:
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State:
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Zip Code:
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Zip Code:
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Phone # (daytime)
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Phone # (daytime)
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Phone # (evening)
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Phone # (evening)
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E-mail Address
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E-mail Address
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Card Type
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Sign Here for charge Authorization: |
___________ | |
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Account Number Exp. Date
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