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176ORDERFORMOrderFormPleaseprintclearlyPleaseprovidestreetandnumberWecannotdelivertoPOboxesPleasecheckoneOccupationaltherapistPhysicaltherapistSpeech-languagepathologistTeacherParentOtherSubtotalShipping**13%Minimum$895Sales TaxTOTAL$$PaymentMethod(InUSFundsOnly)AuthorizedPurchaseOrder#Card#ExpirationDateCVVCodePrintCardholderNameSignatureQtyItemNumberDescriptionColorSizePrice/EachTotalPrice*WereservetherighttocorrectmistakesandchangepricesIfapricechangeismorethan 10%wewillnotifyyoubeforefillingyourorderYourfullsatisfactionisalwaysguaranteed**SomeproductshaveadditionalshippingchargesForovernightshippingortoplaceordersoutsidetheContinentalUSpleasecallforashippingquoteHowdidyouhearaboutusEventAdvertisementMagazineWordofMouthSearchEngineConferenceOtherVisaMastercardDiscoverAmericanExpressCheckorMoneyOrder(enclosed)payabletoFunandFunctionNameCompany/School/OrganizationAddressCityStateZipPhoneFaxEmailShipToNameCompany/School/OrganizationAddressCityStateZipPhoneFaxEmailBillToFunandFunctionLLCPOBox 11MerionStationPA 190661-800-231-6329accounts@funandfunctioncom
