Order Number# 08627  
PRINT OR COPY ORDER  FORM AND SEND WITH MONEY ORDER

Name

STREET

Town

State

ZIP

Phone

E mail

ITEM #
Quantity
Price
each
shipping each
TOTAL
08627
14.95
3.00 Each
ALL PAYMENTS US CURRENCY
send orders to
17.95 U.S each including US postage

 KOKE
Po box 472
Walker Valley, NY 12588