ORDER BLANK 
Hl, ornberger BeOcrvice 
eb Be S70 Peas Loam tree on tAMELIR GN. Y. 

DATEL. pe rie eee meee fo | Oy Se 
HOW SHIP.? 
WHEN WANTED? av 
ap SE aS 9 Si a le I) A VARIE TN¢? 


YOUR COMPLETE ADDRESS: WRITE OR PRINT PLAINLY, your name, Mr., Miss or Mrs., 
give street or r.f.d. No. or P. O. Box No. and state if order is for Exp. shipment. Give name 
of Exp. Office, if different. 
~= 
GILFAN THY SIZE NAME AMOUNT 



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