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Company:
Street Address: 
City:   State: Zip/Postal Code: 

Buyer/Contact:    Customer Ref. No.:
Phone:   FAX:  E-mail:
NET SHAPES to furnish tooling?
Prints for quotation purposes are enclosed?  
Prints are in NET SHAPES possession?

ITEM

QTY

      PART NO./ID & DESC.   REVISION

DELIVERY  DATE

1

2

3

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Revised: 07/07/04