www.genealogyshoppe.com            

To: Genealogy Shoppe/Census View                   Date:_____________
36426 EW 1160                                      GenealogyShoppe
Seminole, Ok. 74868	                           1-405-944-5056

Buyers name (Please Print)____________________________________________ 

Address_______________________________________________________________

City/State__________________________________________ Zip______________ 

Phone Number______________________ Your Email_________________________


Ship to name(if different than buyer)_________________________________

Address_______________________________________________________________

City/State___________________________________________ Zip______________

Please do not enclose cash. No C.O.D.'s. I accept checks & money orders. Please make payable to Genealogy Shoppe. I accept PayPal (credit cards if that is how your PayPal is set up). Be sure to include appropriate shipping and handling. You can get his by going thru the steps of ordering online...going to the point of not submitting your order. Please print.

Catalog # Qty  Title/Author                                    Amount

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	                                              Total $ _________

	                                Shipping & Handling $ _________

	                   Ok. Residents add 9.5% sales tax $ _________

	                                        Amount due: $ _________