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Name of Seller or Company name __________________________________________
What are you are selling ___________________________________________________
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Check Number:__________________________Amount:___________________________
Your E-Mail:_____________________________or Phone #_________________________
Waiver - Please read and signs below
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Name (signature) _____________________________________________ Date_________
Please return this form along with the proper check made out to
Long Island Vettes Inc.
PO. Box 617
North Bellmore, NY 11710