Order Blank 
Mr. 
Mrs. 
Miss 
R. D. or St. 
Post Office 
Ship When 
DISTINCTIVE GLADS Order No. 
EVERETT A. QUACKENBUSH 
and 
EVERETT F. QUACKENBUSH 
NEW CUMBERLAND, PA. 
Date 
(Please Print) 
State 
Amt. Enclosed $ 
If We Are Out of Any Item You Order Shall We— 
( ) REFUND ( ) SUBSTITUTE NEAREST SIZH ( ) SUBSTITUTH NEAREST VARIBTY 
Size Price 
Quantity 
ue 
a 
= 
bo 
=~ 
VARIETY 
Balance Forward 
(Continued on Other Side) 
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