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GRANTS PASS . OREGON DATE RECEIVED 
Date anaes Amount Enclosed $ DATE SHIPPED 
PLEASE TYPE or PRINT ADDRESS PLAINLY 
NAME 
Robe DOR 
STREET AND NO. BOX NO 
POST OFFICE ZONES 5 TATE 
If a variety ordered is sold out may we send you another of equal or greater value Yes [_] or No [_] t 
If no information is given we will substitute the nearest we can in case of shortage 
QUANTITY AMOUNT 
I 
yYNS he 
— 
th Aud 
Any 
(Ne 
ANVIS NV TVAS ‘ATOd 
