HI-LO0 ACHES 
BOX 124 - R.F.D. 2 
LAKE VILLA, ILLINOIS 
Mr. 
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Miss (Please Print) 
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lf We Are Out of What You Order Shall We— 
( ) Refund ( ) Substitute Nearest Size ( ) Substitute Nearest Variety 
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UANTITY SIZE NAME OF VARIETY PRICE TOTAL AMT. 



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TOTAL AMOUNT ENCLOSED 


