Ship Items to:

Name:________________________________________________________________________

Address:_______________________________________________________________________

City, State, Zip Code:____________________________________________________________

Shipping Charges Amount of Purchase = Shipping Cost $00.00 - $10.00 = $2.00 $10.01 - $25.00 = $4.00 $25.01 - $40.00 = $5.00 $40.01 - $75.00 = $7.00 $75.01 - $100.00 = $9.00 Over $100.01 = $12.00 Total

Subtotal:_________________     Shipping (see table at left):_________________     Total:_________________

Make check (in U.S. dollars only) payable to and mail to:

Dubuque County-Key City Genealogical Society, P.O. Box 13, Dubuque, IA 52004-0013

Books are shipped via U.S. Postal Service. Prices subject to change without notice. Discounts will not be refunded. Sales / Local Option taxes included in unit price.

For office use. Date received:____________     Amount received:_____________