Order Form

(This form could be printed out and mailed)

Please find enclosed $28.00 plus postage cost for each copy of the book
" DID SOME CHOARING FORENOON "
Diaries of Charles Harris Burgess

Name _________________________________________________

Address ________________________________________________

City ___________________________________________________

State/Province____________________________________________

Zip Code/Postal Code______________________________________

Country ________________________________________________

E-Mail Address __________________________________________

I have enclosed a [ ] Money Order, [ ] Cheque in the amount of $____.____

Shipping charges:

Within the USA, $3.80 for each book ordered.
To Canada, $5.60 for each book ordered.

Please mail order to:

Esther T. Cornell
6317 Falling Star Lane
El Paso, TX 79912
USA