Paul Cosmides                                                 (530) 894-1276
432 Lawton St.
San Francisco, CA 94122

SOLD TO:                                 SHIP TO: (If not the same)

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Name                                     Name

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Address                                  Address

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City, State, Zip                         City, State, Zip

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Phone Number

|                                              |     |    P  R  I  C  E    |
| Item                                         | QTY |   Each   |  Total   |
|----------------------------------------------+-----+----------+----------|
|                                              |     |          |          |
|----------------------------------------------+-----+----------+----------|
|                                              |     |          |          |
|----------------------------------------------+-----+----------+----------|
|                                              |     |          |          |
----------------------------------------------------------------+----------|
                                                          Total |          |
                                                                ------------                                                                    

Make check payable to "Paul Cosmides".