CCHS Order Form

Please fill out order form, then print and mail with money order or check made payable to:
Custer County Historical Society, Inc.

Post Office Box 334
Broken Bow NE 68822
ORDERED BY: SHIP TO: (if different)
Name: Name:
Address: Address:
City: City:
State: Zip: State: Zip:
 
In case we have questions, please give us either a:
Daytime 'Phone: EMail Address:
Item Author Title Qty. Price Amount
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
 
Shipping and Handling:

for orders up to $10.00 add. . .$2.75
       $10.01 to $15.00         $3.75
       $15.01 to $25.00         $4.75
       $25.01 to $40.00         $5.75
       $40.01 to $50.00         $6.75
            over $50.00         $7.75
Order Amount
  Shipping
(See table at left)
  TOTAL
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