WP id 
P.O. Box 253, GRANTS PASS, ORE. 
Mr. 
INATS 5 testes, cere ee OO ce Me ae a Yee 1 RN. Date ss oe. ee eee 
Miss (Please Print) 
If We Are Out of What You Order Shall We— 
( ) Refund (_ ) Substitute Nearest Size or Variety Shipping Date Wanted ................--..---- 
Quantity Variety Size 
SOT Soe | Pe Me ee oN 
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SO Po ates OPS) Be OF 
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