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| Check One The Above Ship to Address is: | Residential___ | Commercial__ |
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| Account Number:___________ | Visa__ Discover__ M/C__ AMX__ | |
| Signature:__________________ | Date:________ | Expiration Date:____MO____YR |
| Check/Money
Order We do not accept cash or COD orders |
Minimum
Order
Shipped $25.00 |
Plexi Fab
1142 E. Elm Ave. Fullerton, CA 92833
(714) 447-8494 * (714) 738-1142 Fax