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Get VA 2346a 2010

Date Please send a six month supply of batteries for the following device s BRAND NAME MODEL SERIAL NUMBER S BATTERY TYPE AND/OR SIZE ACCESSORIES FOR DEVICE S Shipped separately from batteries VA FORM 2346a July 2010 REQUEST FOR BATTERIES ACCESSORIES Please print out a copy and fill out. 1. Print Last Name - First Name - Middle Initial 2. Print Address Street No* City State and Zip Code 3. Email Address 4. This address is New Permanent 5. Print last four digits of your Social Security Number New Temporary 6. Insert into an envelope and mail to VA Denver Acquisition Logistics Center 001AL-A2-4 PO Box 25166 Denver CO 80225-1666. 1. Print Last Name - First Name - Middle Initial 2. Print Address Street No* City State and Zip Code 3. Email Address 4. This address is New Permanent 5. Print last four digits of your Social Security Number New Temporary 6. .

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