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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