| ORDER FORM |
| Mail along with check or money order to: Norma Croucher 83 Main Street P.O. Box 70 South Brook, Nf Canada A0J 1S0 |
| Name |
| St. Address |
| Address (cont.) |
| City |
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| Phone |
| Ordering Information |
| Canadian Funds Only |
| Item # & Description |
| Price Ea. |
| Qty. |
| Total |
| Subtotal |
| Shipping |
| Total of order |
| Thank You For Your Order |