



7^e 



PITTSVILLE. J 



PHONE 



Name: 









Street t 



i Number: 







City: 





Sta 



Tell us 



how to ship: ( ) 



( ) 



parcel post 

 motor freight 



Tell us 



when to 



ship: 

















Quantity 



Varieties 





























i 



Contii 

 spac 



May we subf 

 1 



me on back if additional 

 :e is required 



stitute a smaller size if rem 

 :o expedite your order? 



( ) yes ( ) no 



