Please Do Not Write Here 
y 
- Postoffice State 
. Express or Freight Office Stamps 
Use this blank if possible—It aids in filling orders promptly and properly 
Received 
Our Order No. 
Amount 
O. K.’d 
Filled by. 
Checked by 
Packed by 
Pkgs. 
Date 
1515 Champa St. Denver, Colo. 

Date oo | ee a gg ee 
Phone KEystone 1351 


« Gentlemen: Please forward the following goods by _(Mail, Express or Freight) 
rh (Miss Amount Enclosed 
”~ Name ; Mr. 
ty Mrs. 
: Rear esti Ree ee A ee Money Order 

Draft 


Cash 

if different from Postoffice 
Total $ 

































(Do not x Z 
write 
in these 4 Name of Goods Wanted 2 sia out 
wo (s) 
be eyes May we substitute for varieties of equal merit? 
( t i OWEN Eosward, _|$ 
ate i LO g cccludse a4 
Have you forgotten anything? Be sure to give your name and postoffice. Read on other side 
about postage. How do you want goods shipped? (Please circle routing at top of page, or 
mark here). 
TCLAKINALIUIN COMLITLRC TION _ 

