Item	Desc.	Qty	Unit Price	Subtotal	Discount	Subtotal After Discount
Total Before Discount:				$
Total After Discount:				$
Shipping Fee:				$ 0
Sales Tax:				$ 0
Grand Total:				$ 0

Reference Number	523
Payment Method	Credit card payment
Is partial shipment ok if item is back ordered?

Shipping Address:
First Name
Last Name
Phone Number
Other Contact Number
School Name
Address
City
State
ZIP Code
Country
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