Order Form

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PO Box 419, Accord MA 02018-0419 USA
Phone: 781-982-8100
Fax: 781-871-9989

Bill To / Ordered By (Please Print)

Ship To    (ONLY if different from "Ordered By")
Name:  
Name:  
Address:  
Address:  
City/State/Zip:  
City/State/Zip:  
Day Phone:  
Eve Phone:  
* E-mail:  
* E-mail:  

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Account Number: Expires: Security:
       
       
       
       
   
/
   
         

Shipping & Packaging (US Only)

Up To $39.99 $8.95 $60.00 to $99.99 $12.30
$40.00 to $59.99 $11.50 $100.00 & Over $19.75
Qty Item # Description Unit Price Total
         
         
         
         
         
         
         
         
         
         
Total $  
Add 5% Sales Tax (Tax for MA Non-Food Items)  
Shipping & Packaging (See Chart Above)  
Total Order Amount  

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