» Name 



FLORAL PARK, NEW YORK. 

 Date of Order, 





J90L 



\ Pnfif Office 



I County State . 



, Enclnaed I .<if.nd ynti $ for tiyhich ple.^ae send me the fnlleyjDing afHr.le<i : 



\ Quantity 



ARTICLEIS NA/AIMTEID 



price: 











































































































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