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1

3

4

Capital

Gala

Octave

Baltic

Which type of pen do you have ?

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Date of Purchase

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Place of purchase:

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2

From which range?

Dais

6

Minuet

5

Other Pen? - Please type model name:

Whimsy

Tuskini

Trinity

Dolfini

Dreamtime

Fleur de Lys

Celtic Knot

Classics

Darfur

Hands of Hope

Sands of Hope

Woven Spirit

Key

Nouveau Petite

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Elegance

America 400

Sterling Silver

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Gem Set

Celtic

 Regal

Nouveau

 Lily

Luxury

157 Pen

Ballpoint

 Pencil

Musical Tribute

Thoroughbred

 Spirit USA

Collectors

Dreamtime

 Athenian Key

Celtic Spirit

 Blue Gum

Prestige

From which range?

Please indicate design

Barrier Reef

 Federation Lace

 Victorian Scrolls

 Vintage Harvest