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LITERATURE REQUEST FORM
P= lease PRINT this form; FILL OUT; and FAX to: 954-894-6665=
A= ll requests are shipped STANDARD delivery from UPS.
TODAY'S DATE:  
YOUR INFORMATION:
Name:      
Company:      
Phone:      
E-mail/fax:      
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SHIP- TO INFORMATION:
Name:      
Company:      
Address:      
City/State:      
Phone:      
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QUANTITY MANUFACTURER ITEM STYLE #/ DESCRIPTION / COLOR
example: 2 Davis Webb Chair Series brochures
1 Loewenstein "Lariat" fabric memo sample- Camel 003
     
     
     
     
     
     
     
     
     
     
     
QUESTIONS? Please call Kara Bierman at the Bierman Group: 954-894-6662 ext 1<= /td>      
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