TEAR OFF 
Order Blank DISTINCTIVE GLADS _ Order No. 
EVERETT A. QUACKENBUSH 
and 
EVERETT F. QUACKENBUSH 
MIDDLETOWN, PA. 
Mr. 
I cerca er ee es ee a a te lk OA Ceo oe ae, 
Miss (Please Print) 
R. D. or St. 
Post Office State 
MER Aerie egies a ee Amt Wnelosed $ 
If We Are Out of Any Item You Order Shall We— 
( ) REFUND ( ) SUBSTITUTE NEAREST SIZE ( ) SUBSTITUTE NEAREST VARIETY 
Quantity VARIETY ‘Size | Price 
Se rt Se re ee ee 
_ 
= 
ae de oe ee 
oe a 
a 
ig 
rary 
co 
bh | wo 
=} © 
_ 
s© 
Pennsylvania Customer Only—1% Sales Tax 
