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M www.barnesspecialtygases.com www.ramweldingsupply.com Phone Number: Date: Individual BILLING INFORMATION Shipping Information Address: Address 2: Address 2: City: City: State / Zip: Same as Billing Address: State / Zip: Indicate your invoicing preference. Your invoices can be printed & mailed, faxed or emailed (TIFF format) to you semi weekly or monthly. Fax Number (For Invoicing) Email Address (For Invoicing) Sent: Semi Weekly Monthly BUSINESS INFORMATION Name of Busin.

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