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: City: City: State: State: Zip Code: Zip Code: Residential or Commercial Address: Residential or Commercial Address: Company Website: Contact Name: Phone Number: Fax Number: Email Address: Tax Exempt: Yes / No (circle one) If yes, please return your Tax Exemption form with order. SIC Code: Encore Item # Description (including color if necessary) Case Cnt Quantity Price *Minimum order amount for an Open Account is $750. *Orders below $750.00: Must be placed on credit card (Vis.
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