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Country Roots Printable Order Form

Check Money Order Visa Master Card Discover

Card #Expiration Date

Name
Street
CityStateZip

E-Mail

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QtyItem nameColorsCost

Enter any comments here

Sub-total
Sales Tax (PA ONLY) 6%
Shipping Cost
Total

Print and mail form to:
Country Roots
6927 Bedford Valley Rd
Bedford PA 15522

Thank You for your order, Come back soon!!!