Freeport Area Historical Society
P.O. Box 107
Freeport, PA   16229
724-295-9412


Shipping Address:

Name______________________________

Street ________________________________

City _______________________________ State _________ Zip Code _________


|Qty  |			Description		|Price Each  |	Total   |
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|        |                                                                      |                  |              |
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|       |                                                                       |                  |              |
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						Sub Total _______________

						
						    Total _______________


Sorry, credit cards are not accepted.  Mail the above form with check or
money order (Payable to Freeport Area Historical Society).  Thank you for your order.

Please allow 4 to 6 weeks for delivery of your order.






Office use only
Date Received:__________________

Invoice: _______________________

Date Shipped: __________________