GE PSHS6TGXSS - Profile 26' Dispenser Refrigerator - Page 42

For Purchases Made In Iowa: This form must be signed and dated by the buyer and seller prior to the consummation of this
sale. This form should be retained on file by the seller for a minimum of two years.
BUYER: SELLER:
Name Name
Address Address
City State Zip City State Zip
Signature Date Signature Date
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