Confidential info!

Sources fmike at SAVOYNET.COM
Fri Oct 24 00:28:22 EST 1997


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Please Print

Name  _________________________________________________________


Address _______________________________________________________


City, ________________________State______ Zip__________________

Telephone #____________________  FAX_________________

E-mail Address ________________________________

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Please Fill out, Print and send along with your payment to;

      Mike  Buggy  
    1878 Cider Press Rd.
     Manhiem Pa 17545

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