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Quantity Model/Port Number Description Unit Price Amount
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Subtotal ____________
Shipping and Handling ____________
NYS Sales Tax 7% ____________
Total ____________
Note: Please add 7% sales tax only if you reside in New York State. Shipping and handling charges extra.
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Date of Expiration ___________________________
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Erie
(814) 453-6794
Headquarters
Jochum Business Systems
29 N. Main St.
Jamestown, NY 14701
(716) 664-4310 Phone
(716) 664-9088 Fax

Olean
(716) 372-6195