SHIP TO:                                                                                           PRINT

 

Name____________________________________________________________________

 

Adress___________________________________________________________________

 

          ---------------------------------------------------------------------------------------------------------------------

 

City State Zip_____________________________________________________________

 

e-mail___________________________________________________________________

 

 

quantity      item #                 item                                     color/size                           cost $

 

                                                                                TOTAL COST OF ITEMS:__________________

 

                                                                                Shipping and Handling:             + $6.00

 

                                                                                TOTAL  COST:  _________________________

 

Send check or money order to:

              

          Bethlehem Heritage Society

          PO Box 148

          Bethlehem NH 03574