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NAME: ________________________________
PHONE: _________________________(Home)
ADDRESS: _____________________________
PHONE: _________________________(Work or cell)
CITY: ____________________________
PROV/STATE: ________________
POSTAL CODE/ZIP CODE: ___________________
Email: _____________________________________
Vehicle Plate Number: ________________________
Make and Model: ____________________________
Color: _________________
Trailer Plate Number: _________________________
Boat Make or Name: __________________________(ie description)
Registration #: _______________________________
Price $ 205.00 GST @6% 10.25
________________ Total $215.25 |