ORDER BLANK. 



Date 190"2. 



Little Silver, Mew Jersey. 



Enclosed jind the sum of $ for u hich send the following goods: 



Quantity. 



VARIETY AND SIZE. 



' Amounts. 



, DOLLARS, CK>TS. 























|- 





























j. 

















i 







! 



! 















- 

















1 















1 























i 



























i 









Total amount of order 



1 







Name 



Mr., Mrs. cr Miss— write plainly. 



Post Office 



County State 



Ship by to 



