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Order Summnary

Order #41582

Subtotal	$500
Estimated Tax	$5.55
Shipping	$15

520.55

USD

ORDER TOTAL

First Name*

Company

Last Name*

Email Address*

Address

City*

Zip/Postal Code*

Telephone*

State/Province*

Country*

Fax

Ship to this address

Ship to different address

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First Name*

Company

Last Name*

Email Address*

Address

City*

Zip/Postal Code*

Telephone*

State/Province*

Country*

Fax

Use Billing Address

Fields marked with (*) are required

	Method	Deliver Time	Cost
	Free Shipping	10 to 15 days	Free
	Standard post	5 to 7 days	$12
	Next day	tomorrow	$20

Credit Card
Paypal

Card Number*

Expiration Date*

CV Code*

Name on Card

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