I 
All ( 
i ORDER FORA 
! DANIELS 
| Portal ) 
| Address ) 
( 
| Nearest Railway Station 
| and distance from same 
It is of the greatest 
1 The Railway Station sh< 
^oin or Treasury Notes should be Registered. 
Autum 
» BROS. Ltd.', Nor 
AMOUNT E 
Cheque 
Money Order . . 
Postal Order . . 
Treasury Notes 
bounty 
Coin or Stamps 
Total 
n 1 
wi 
NCL< 
£ 
92 
LCl 
DSEI 
s. 
2. 
[Y. 
5: 
cl. 
mportance to write clearly the Name and Address of 
mid always be given. 
Dale 
the sender. 
1922. 
QUANTITY 
REQUIRED. 
S. 
d. 
j 
! 
i 
