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Order Form

Send cash, check or money order to:
Shirley Rose
411 E. Huntington Dr. #107-234
Arcadia, CA 91006

Ship To:

Name _______________________
Address _____________________
____________________________
Phone ____________________
E-Mail ______________________

TOTAL NUMBER OF ITEMS: __________________
SHIPPING COSTS: ____________________________
TOTAL AMOUNT ENCLOSED: _________________

Thank You For Your Order