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Customer Note:
This form must be on the end user’s letterhead and signed by a company
officer. |
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--------------- Copy from below line to end of document ----------------- |
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| Company: | _________________________________ | |
| Street Address: | _________________________________ | |
| Telephone Number: | _________________________________ | |
| Fax Number: | _________________________________ | |
| Authorized Officer’s Name: | _________________________________ | |
| Authorized Officer’s Title: | _________________________________ | |
| Authorized Officer’s Signature: | _________________________________ | |
| Date: | _________________________________ | |