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E. Lancaster PA 17602 CREDIT CARD DETAILS VISA MasterCard Discover American Express Name of Cardholder Card Expiration Date CVV Phone Email Signature. Anniversary Medal Order Form Pre orders paid in advance must be received by June 15 2017 Name Phone Street Address City State Zip PLEASE PRINT Bronze 25 each x Silver 65 each x Silver and Bronze Set 75 per set of 2 x Mailing/shipping 2 each medal TOTAL Tax add 6 of total Amount enclosed or to be charged Please make checks...

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