NAME:
________________________________________________________________________________________________________________________
TITLE:
___________________________________________________________________ PHONE:
_______________________________________
ADDRESS:
___________________________________________________________________________________________________________________
FAX (Optional): __________________________________________
EMAIL:
______________________________________________________
ADDITIONAL DETAILS:
___________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
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Price:______________ Shipping:______________ Total
Amount:__________________________
Shipping
Address:__________________________________________________________________________________________________________
City, State, &
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Signature:_____________________________________
Date:_____________________
Please mail order with Cash or Money Order (ONLY) payable
to:
Chris Reid
to the following
address:
180 Lone Ct. Florence, KY 41042
You may also pay via Paypal to CPCP@Home-Childcare.org with a credit
card or check.
Email:
Sales@Home-Childcare.org
with any questions. Thank you!