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RESS CITY STATE ZIP CODE DESTINATION CITY ORIGIN CITY (IF DIFFERENT FROM ABOVE) STATE ZIP CODE PHONE NO. INVOICEE OR COD REMIT TO NAME (IF DIFFERENT FROM SHIPPER) CUSTOMER NO. ADDRESS STATE ZIP CODE P.O. NO. CITY STATE ZIP CODE STORE NO. DEPT. SPECIAL INSTRUCTIONS ATTN. COD FEE NO. SHPNG UNITS PREPAID PKG TYPE COLLECT HM COD AMT $ DESCRIPTION OF ARTICLES, SPECIAL MARKS AND EXCEPTIONS EMERGENCY CONTACT Phone: CUSTOMER CHECK OK FOR COD AMOUNT? NMFC ITEM NO.

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