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	Special Requests		Select none Champagne(0-$10) Champagne($10-$20) Champagne($20-$30) Champagne(over $30) Wine(0-$10) Wine($10-$20) Wine($20-$30) Wine(over $30) Flowers Roses(dozen) Roses(single) Banner Beer(6 pk) Beer(12 pk)
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	Free DVD with information on a swimming pool from EndlessPools.com*		Select yes, send me a free DVD! Not now, please send later! No, not right now!
	If yes, What's your mailing address?