| Name: | Notes: Remove line from reel. Enclose this form for easy identification. |
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| Address: | ||
| City: | ||
| State: | Zip: | |
| Phone: | Time: ________ | |
| Email Address | ||
| Reel Make and Modle: | ||
Reel Condition, Issues, Noises:
|
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$__________ |
||
$__________ |
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$__________ |
||
$__________ |
||
$__________ |
||
$__________ |
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| Part: | $__________ |
|
| Sub Total | $__________ |
|
| Tax | $__________ |
|
| Estimated Shipping 1st Reel $8.00 | $__________ |
|
| Estimated Ea. Add. Reel $2.00 | $__________ |
|
| Total | $__________ |
|
*** Actual Shipping Charges will be applied when they exceed the above amounts.
| Office Use Only | © 2007 Corks Reel Service | |
| Date Received | ||
| Date Shipped | ||
| Tracking Number | ||
| Inspection Notes:
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