@VAR_INCLUDE_HTML=header.txt_@ @VAR_INCLUDE_HTML=custhdr.txt_@

Bill To:

 


@VAR_BILLNAME_@
@VAR_BILLADD1_@ @VAR_B2_@ @VAR_BILLADD2_@ @VAR_B3_@ @VAR_BILLADD3_@
@VAR_BILLCITYLINE_@
Ship To:
@VAR_SHIPNAME_@
@VAR_SHIPADD1_@ @VAR_S2_@ @VAR_SHIPADD2_@ @VAR_S3_@ @VAR_SHIPADD3_@
@VAR_SHIPCITYLINE_@
PO #:
Ship Via:
Payment Method: On Account
Other
      Card# Expires
Special Notes:




@VAR_INCLUDE_HTML=footer.txt_@