ORDER BLANK 
THE GLAD PATCH 
ALFRED N. CORRINGTON 
NORMAL - ILLINOIS 
Date _ 
Send to ___ 
Postoffice _ _ State _ 
Street _County _ 
Express office _Ship When 
Amt. enclosed: Bank Draft, Check, M. 0._ 
Indicate size (L) Large; (M) Medium; (S) Small. 
Quantity 
Variety 
Size 
Amount 
Keep a Copy of Your Order 
