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| Name | _______________________________ |
| Address | _______________________________ |
| City | _______________________________ |
| State | _______________________________ |
| Zip Code | _______________________________ |
| Phone | _______________________________ |
| Fax | _______________________________ |
| _______________________________ | |
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| Subtotal |
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| Shipping |
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| RI residents add 7% sales tax |
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| ORDER TOTAL |
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Last revised April, 2001