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Garden State Apartments, LLC 211 Warren Street Newark, NJ 07103
Billing Information:
NAME/COMPANY
ADDRESS
ADDRESS
CITY
STATE, ZIP
PHONE
URL
EMAIL
Your representative is: ________________________
Fax Orders: (973) 215-2450 Telephone: (866) 954-2787 or (973) 954-2787
Contact Information: (if different than billing information)
NAME
ADDRESS
CITY
STATE, ZIP
PHONE
Order Information:
Date
Qty.
Description
Category
Price
TOTAL
ORDER NOTES / DESCRIPTION:
.
ORDER TOTAL
Method of Payment: Check or Money Order* /Visa /MasterCard /Discover /American Express *Please make check or money order payable to: GARDEN STATE APARTMENTS, LLC.
CREDIT CARD NO.
EXPIRATION DATE
NAME ON CARD
CARDHOLDER'S SIGNATURE
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Check or Money Order* /