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Mail Order Form
Please print two copies of this form and keep one for your records.
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Just
out of Reach
18701
Townline Rd.
Mokena,
IL 60448
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Please
enclose your check
made payable to:
Z
- Performance
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Date: / /
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1
Item - $12.95
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Free Shipping!
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Total:
$12.95
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2 Pack
- $21.95
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Free Shipping!
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Total:
$21.95
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3
Pack - $30.95
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Free Shipping!
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Total:
$30.95
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4
Pack - $39.95
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Free Shipping!
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Total:
$39.95
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FOR PRIORITY 3 - 5 DAY
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SHIPPING ADD:
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$6.00
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Shipping Information
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Name:
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Address:
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City:
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State:
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Zip Code:
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Phone: ( )
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E-mail:
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Style #1 Qty.
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Style #2 Qty.
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Style #3 Qty.
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Style #4 Qty.
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Total amount enclosed: $
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Please allow 10-14 business days for delivery
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