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Submitted URL: https://www5.scansource.com/e/704223/forms-m19t4apy0swofns-/45ybsx/1315426602/h/-eIeLDCiAs4dMnfFIJRklPxu96T_rGlo7oV5tkcfDdY
Effective URL: https://scscinteractive.wufoo.com/forms/m19t4apy0swofns/
Submission: On November 20 via manual from US — Scanned from CA
Effective URL: https://scscinteractive.wufoo.com/forms/m19t4apy0swofns/
Submission: On November 20 via manual from US — Scanned from CA