MAIL IN ORDER BLANK

NAME: ________________________________________________________

STREET ADDRESS: ________________________________________________________

_______________________________________________________

CITY: __________________________ STATE: ________ ZIP: _________

ORDER

ITEM	DESCRIPTION	QUANTITY	UNIT COST	TOTAL COST
1
2
3
4
5
	West Virginia Residents Must Add 6% Sales Tax
			TOTAL

SEND PAYMENT BY CHECK OR MONEY ORDER TO:

PENNY LINDER

83 SHEFFIELD COURT

BRIDGEPORT, WV 26330 USA

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