LIQUOR/WINE FORMS>
Black Box #751947-BBXNA10083 $5.00 (Receipt On 1, Write UPC) El Paso, TX 2/28/10 Postmark 3/15/10

Price: $0.50

Purchase (1) 3 L Box of Black Box Wine, send in this completed form,
write UPC in space provided. Send in the original CRT
with the price circled. 2/28/10 Postmark 3/15/10