



by__ 
ORDER BLANK 
KELLER'S 
909 MAINE ST., QUINCY, ILL. 

Money 
enclosed Amount 
Date 
Draft or Check . . $ 
Please ship merchandise named below 
Money Order... 
(State here if wanted by mail, freight or express.) 
Name 
Street No. 
R.F.D. No. 
Pos Office 
QUANTITY 
Cash (Registered) . 
Stamps ...... 
P.O. Box No. Total... . $ 
State 
ITEMS AMOUNT 
Total $ 

(OVER) 
