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* 1. First and Last Name:

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* 2. Phone:

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* 3. Best time of day to reach you:

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* 4. Mailing Address:

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* 5. Billing Address (if different):

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* 6. Email address:

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* 7. Please list your order below:
(Listing the ITEM NUMBER, DESCRIPTION/COLOR and QUANTITY)

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* 8. Payment Method: I will contact you ASAP to process your order and take payment once I have a chance to review your order and make sure your discount is applied!!

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* 9. I'm interested in hosting an party and saving 35% on my order today!!

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* 10. THANK YOU! Thank you for investing into you and your family in this HUGE way! Thank you for investing into our small business. Thank you for making such an intentional decision to make your home a safer haven! We love you!

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