mail to: Preston Steed
                   305 Grande Ave.
                   Del Norte, CO 81132

Ordered by:                                 |Ship to: (if different from "Ordered by")   |

Name                                        |Name                                        |

Street Address                              |Street Address                              |

City                                        |City                                        |

State                    |Zip               |State                  |Zip                 |

Qty |  Item/Title                           |   Size   |   Inside Mat Color  |   Price   |

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    |                                       |          |                     |           |

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                                                   |        Shipping       |     Free    |

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Card#                             Expires:          Ph.#(         )                      |

Name on card:                               Signature                                    |

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