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ALS GLAD PATCH 
AL AND JESSIE AMSLER 
4052 MADISON STREET SIOUX CITY 6, IOWA 
Name Date 
R. FE. D. or Street 
Post Office | State 
IN CASE WE ARE SOLD OUT, SHALL WE 
Refund [] Substitute Nearest Size? [] Substitute similar or better Variety? [] 
Quantity | Size Variety | Price 
de 
9 
= 
Se ¢ 
TOTAL 
Iowa residents add 2 per cent sales tax. 
15 
