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FirstName 12 50 0 1
LastName 12 50 0 1
CompanyName 12 50 0 1
Address1 12 50 0 1
Address2 12 50 0 1
City 12 50 0 1
State 12 2 0 1
Zip 12 10 0 1
Phone 12 25 0 1
Fax 12 50 0 1