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For Your Internet Information^™

If you wish to pay for your rental space by check or money order please submit this form to reserve your space.
Remember to email your picture in JPEG or GIF format to. labizzlady@yahoo.com

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Please provide the following contact information:

Date

First Name Last Name

Title

Company

Street Address

Address (cont.)

City State Zip

E-mail

Phone: ( ) ext:

Please provide the following ordering information:

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# URL Site Description

Please make check or money order payable and mail to:
Print this form and include with you order.

Cheryl Rogerss
PO Box 78544
Los Angeles, CA 90019

First Name	Last Name
Title
Company
Street Address
Address (cont.)
City	State Zip
E-mail
Phone:	( ) ext:

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