Name: _________________________________________
Address: _______________________________________
City/State/Zip: ___________________________________
E-mail: ________________________________________
Item # Qty Cost Ea Total
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(See Chart for Cost) Shipping: _________
Payment to be made by Money Order or Cashier Check
Payable to: Steven M Kraslen
Mail To: SM Kras Merchandising
7537 N Maplewood Ave Unit C
Chicago, Illinois 60645