| the Connerys on-line order form |
| Tell us Who you are | send your $ here |
| Name: __________________ | the Connerys |
| Address: _________________ | 1001 Mayflower Rd |
| City: ___________________ | #104 |
| State: _____ Zip code: _________ | South Bend, IN |
| e-mail: _________________ | 46619 |
| What you're ordering | How many you want |
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