Date

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(Filling out this form does not automatically create an order. Use it for manually entering data only. You may print out this reservation form and mail it to us or fax it to: 804-739-2276.)

ITEM DESCRIPTION	Unit Price	Quantity	Shipping and Handling	VA Residents add 4.5% sales tax	TOTAL
Clara Barton Doll	$145.00		$10.00