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PITTSVILLE , 

 PHONE 



Name 



Street § Number 

 City: 



Sta 



Tell us how to ship: ( ) parcel post 



( ) motor freight 



Tell us when to ship: 





Quantity 



Varieties 































Continue on back if additional 



space is required jij 



May we substitute a smaller size if recjir 

 to expedite your order? 



( ) yes 



( ) no 



