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| Costco Order Form |
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| COSTCO Service now provided by Heavenly Helpers |
| 1525 W 12 Street, Suite 11 |
| (541-991-1750) |
| Order/Delivery the 2nd and 4th Thursdays/Fridays of the month) |
| (Pick up at covered delivery dock, East end of building) |
| (Use the TAB key to advance to the next line in the form) |
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