Order Blank 
For High Grade Tested Seeds 
WRITE YOUR ADDRESS PLAINLY AND IN FULL in 
the blanks below, and use another sheet for other matters you 
wish to write about. This enables us to FILL ORDERS 
RAPIDLY and correctly, and your inquiries will not be so 
apt to be overlooked. For full instructions about ordering, etc., 
see directions page 96 0} catalog. 
D. V. BURRELL SEED GROWERS CO., Rocky Ford, Colo. 
Gentlemen: In accordance with terms of your Descriptive Catalog, 
Check how goods please forward to: 
are to be sent: 
Date 
19 
Parcel 
Post 
Express 
□ 
□ 
Frei 
ight 
Name- 
(First Name) (Middle Initial) 
(Last Name,' 
Postoffice- 
Rural Box 
Route-No___State- 
Please give both your Route Number and Box Number if on a Rural Route 
Street 
Address 
Number . 
Cash ... 
Stamps . 
Check . 
Draft . 
Refund . 
P. M. Order. 
E. M. Order. 
Total . 
Do Not Use This Space 
O. K.’d by . 
Shipped via . 
Date rec’d . 
Date sent . 
Filled by . 
Chedted by . 
Packed by . 
Number packages . 
Postage . 
1/ 
QUANTITY 
NAME VARIETY 
PRICE 
1/ 
Dollars 
Cents 
I 
* 
£ 
' 
2 
s 
D 
E 
O 
O 
O 
U 
c n 
HH 
cn 
HH 
E 
h 
E 
h 
£ 
1 — i 
2 
M 
V 
H 
H 
W 
h 
l-H 
& 
& 
£ 
h 
HH 
ON 
0 
2 
DO 
DOj 
W 
w 
on 
< 
w 
< 
w 
PXH 
Oh 
-- 
Amount carried forward other side: 
EXTRA SEEDS FOR THE NAMES OF THOSE WHO GROW GARDENS. SEE OTHER SIDE. 
