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ArTi s � a � l � r <br /> TION PICTUaIii, ING.a <br /> n S1�ar*. Chalr an <br /> Exhibition Request Form <br /> Please complete all sections on this form and fax it to: (314) 909 -0879 <br /> Attention: Shannon Bishop <br /> " f you are exempt from state sales tax, please be sure to fax a copy of your STATE sales tax <br /> exemption certificate with this form (must be signed and dated)*'" <br /> Organization Name: Centerville Parks and Recreation <br /> Contact Person: Brian Peterson Job Title: Committee Member <br /> Phone Number: 651- 793.7432 Fax Number: <br /> Email: brian0petersoncabin.com <br /> Mailing Address: Billing Address (if different from mailing): <br /> Brian Peterson <br /> 1668 Hunters Trail <br /> Centerville MN 55038 <br /> Shipping Address (cannot ship to a PO Box, <br /> Must be a physical address): <br /> Brian Peterson <br /> 1668 Hunters Trail <br /> Centerville MN 55038 <br /> Credit Card Information (Optional): <br /> (we accept VISA, MasterCard, American Express and Discover) <br /> Name as it appears on card Card Number Expiration <br /> ❑ Please check this box if you would like us to keep this credit card on file for future orders <br /> How did you hear about us? <br /> ❑ Website <br /> ❑ Magazine Ad <br /> ❑ Studio referral <br /> ❑ Convention, please specify: <br /> ❑ Referral from a current customer, please specify: <br /> ❑ Referral from an equipment provider, please specify: <br /> X Other, please specify St Paul MN Parks and Rec <br /> Are you renting equipment? If so, from who <br />