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S GENERAL SERVICES WAREHOUSE OR FAX TO: (573) 751-1574 P.O. BOX 570, JEFFERSON CITY, MO 65102-0570 WAREHOUSE CONTROL NO. PLEASE SEND ME THE FOLLOWING LITERATURE: QUANTITY* REQUESTED WAREHOUSE USE ONLY SUPPLIED STOCK NO. DHSS WAREHOUSE USE ONLY TITLE (PLEASE LIST EXACT TITLE) *THE COST OR A LIMITED STOCK MAY RESTRICT QUANTITIES SUPPLIED. THE INFORMATION BELOW MUST BE COMPLETED IN FULL TO PROCESS YOUR REQUEST. REQUESTER S ORGANIZATION NAME DATE 4 CONTACT PERSON S NAME 4 SHIPPING A.

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