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PRINT OUT ORDER FORM COMPLETE INFORMATION AND MAIL WITH $25 CHECK TO: (includes , tax, shipping & handling)

• Diane Lipman
• 1872 Shalom Drive
• West Bend, WI 53090

Name

Address

City State Zip

Body color -check one

periwinkle blue khaki golden tan light pink

Hair Color -check one

chili red berry blue natural white black curry yellow