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Name of person ordering menarche box:
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Relationship to Recipient:
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Phone Contact:
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Name of Girl Receiving Menarche Box:
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Age of Recipient:
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Favorite Color of Recipient:
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Date Needed By:
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Number of boxes requesting:
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Amount paying (note: each box is $20 each, includes postage and handling):
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Address (Name, Street, City, State, Zip Code):
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