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ORDERED BY: (please PRINT)
Name
:__________________________________
Street
Address :__________________________
City
:___________________________________
State
:__________________________________
Zip
:____________________________________
Daytime
Phone :__________________________
E-Mail
:_________________________________ |
SHIP TO: (if different)
Name
:__________________________________
Street
Address :__________________________
City
:___________________________________
State
:__________________________________
Zip
:____________________________________
Daytime
Phone :__________________________
E-Mail
:_________________________________ |
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BOOK - $ 25.00
SHIPPING & HANDLING - $ 3.00
Make your check payable to Vahram Gurjian
Send your payment to:
D.V. MUSIC
31-68 32ND ST.,
L.I.C., NY,
11106-2533
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