ORDER BLANK. 



Date - - 1904.. 



0". T. XaO"V^ETT, 



Little Silver, New Jersey. 



EnrloRftd. find thp. Rn.irt, nf ^ for ij)hich send the folloming goods: 



Quantity 



• 



VARIETY AND SIZE. 



Amounts; 



DOLLARS. 1 CEXTS. 

























« 

































„.:.._..„„„.. _„ 





_ 

















„ _ 











• 































- - 









- - - 









i 

































Total amount of order 





• 









J^ame 



Mr., Mrs. or Miss— write plainly. 

 Post Office ... 



County „ _ State. 



Ship by _ „ to 



