Ars Polona S.A.ul. Obroncow 25
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Polish Postage Stamps
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| 1. Name | .............................................................................................. |
| 2. Address | ..............................................................................................
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| Q - ty | Name of issue | Currency* EUR USD GBP |
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. TOTAL: ......................
| Date ............................... | Signature .............................. |
* choose currency of payment
(cross unsuitable ones out)