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Please print this form and mail with your payment.
Name_________________________
Address_______________________
City__________________________
State___________Zip___________
Age__________________________
Phone________________________
Fax__________________________
Shipping & Handling
Please Add $2. Please make payment payable to:
Paula Nall
515
E. Strohm
Haxtun, CO 80731
(970) 774-3380
OR