In Focus Portrait -
Online Order Form
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Your Picture/Profile
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Name:________________________________________________________________
Mailing Address:______________________________________________________
City, State,
Zip:________________________________________________________
Phone:__________________________
Email:________________________________
Profile
Information:
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Payment
Information:
Make Check Payable To: IBSA,
Inc.
(Or Money
Order) 629 SE Quincy,
Suite 102
$125.00
Topeka, KS 66603-3921
Allow Two to
Three Weeks Delivery
