6 
taore wee Abas CmALS RULRLETS 
ORDER BLANK 
Seep ands G1. GARUS 
19 Woodside Circle - Hartford 5, Conn. 
CIC Cup 
a ASsalsa|sds| So 
Date Amount Enclosed 
iV) 

Name 

t 
or 
Address 
Express Office (if different from Post Office) 
| “05 
NO. SIZE VARIETY PRICE 00 


| 
~“ 
o 
a|2 | 
olen o 



TOTAL 
0 
00 
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