Order Form

Name of Publication xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxPrice

____________________________________________________________________ $_____________

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Total Price $ ______________

Check wtih Faye for postage amount --------------------------------------- Postage ---- $_______________

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Total with Postage $_______________

Your Name_________________________________________________________________

Address ____________________________________________ CIty___________________

State __________________________ Zip Code ___________________________________

Mail To: Lewelling Quaker Museum, P. O. Box 245, Salem, Iowa 52649