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[null,"Nom de votre entreprise"]
[null,"Numéro civique et rue",{"$nulls":3},"Tél.","(413) 555-0190"]
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[null,"Ville, État/province, code postal",{"$nulls":3},"Courriel","untel@exemple.com"]
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[null,"Rappel – Merci d'inscrire le numéro du présent état de compte sur votre chèque.",{"$nulls":4},"Total",0]
[null,"Modalités – Solde à payer dans les 30 jours"]
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[null,"REMISE"]
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[null,"N° état de compte",null,"(compléter)"]
[null,"Date",null,"2004-03-23"]
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[null,"Règlement ci-joint"]