Freestyle 634 Xterra, 716 Xterra Attn Individual Returns 47-50 33rd Street Long Island City, NY

Attn: Individual Returns

47-50 33rd Street

Long Island City, NY 11101

(718)-729-8890

Battery	$ 4.00
Case	10.00
Bezel	6.00
Band(Polyurethane)	12.00
Band(Leather)	12.00
Band(Metal)	20.00
Band(Nylon)	7.00
Processing and handling	8.50
	________
Total	$

Check or Money Order

Master Card

Visa

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Account#Expiration Date

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Printed Name

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Address

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Phone Number

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Signature

716004-1-2