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History of St. Charles County, Missouri
(1765-1885)

Order Form

Please print this form and mail it with your check or money order.

Customer Information (please print clearly)

Name:____________________________________________________________

Address:__________________________________________________________

City:_____________________________________________________________

State:___________________________________  ZIP Code:________________

Shipping address (if different from above)

Name:____________________________________________________________

Address:__________________________________________________________

City:_____________________________________________________________

State:___________________________________  ZIP Code:________________

 

Number ordered:___________	x   $19.95	$_______________ Subtotal
Add Shipping & Handling:	$3.00 each	$_______________
		$_______________ TOTAL

Please make checks payable to Patria Publishing. Allow 2 weeks for shipping.

Mail to:

Paul R. Hollrah 1205 E. 10th Street Sand Springs, OK 74063