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Stevens Data Eagle Express Online Order Form


# Fields must be filled up for submission

First Name #
Last Name #
Email Address
Address Line1 #
Address Line2
City #
State # Zip #
Daytime Phone #
Simple Order Form Via Email Submission
Item Name Qty @Price SubTotal
@
@
@
Sales Tax: Sales Tax will be computed automatically for Residents in: Alabama PA
Shipping&Handling: If subtotal is 1-49=$15, 50-99=$10, 100-149=$5, >150=free!
TOTAL:

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