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First Name

Last Name

Company Name

Email Address

Address

City

State/Province

Zip/Postal Code

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Order Notes

Your order

Photo	Product Name	Total
	Winter Black Jacket x 2	$36.00
	Swan Crop V-Neck Tee x 3	$115.00
	Blue Solid Casual Shirt x 1	$68.00
Cart Subtotal		$180.00
Shipping and Handling		Free Shipping
Order Total		$250.00

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