
| Please provide the following ordering information: |
| QTY | CODE | QTY | CODE |
| Total in US$ | |||
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Credit card |
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Cardholder name |
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Card number |
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Expiration date |
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Name |
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Street address |
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Address (cont.) |
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City |
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State/Province |
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Zip/Postal code |
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Country |
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FAX |
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URL |
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Minimum order is US$300.00
The above price subjected to handling fee
For mass order please send e-mail for further instructions
