Jacqui's Originals  28620 192nd Pl SE  Kent, WA  98042
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Item#/Description           Qty.  Price ea.  Total

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                                   Subtotal:
Ship method: ___Priority $ 3.75              ---------
             ___Express  $15.00    Shipping:
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Payment via: ___Check/Money Order     Total:
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             ___VISA

Card#:                              Expires:
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Signature:
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