Name
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Street Address
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City
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State
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Zip
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Phone
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Email
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Right hand
____
Left hand
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small/medium
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large/extra
large
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Number of packs at $68.00 each
____ X $68.00 + shipping = ________
please
add 4.20 for each pack for shipping
Make check out to Ruth Sears
Check must accompany order!
From _________________________
_________________________
_________________________
Ruth Sears
827 Summit Loop Rd.
Grants Pass, OR 97527