This form is to be filled out in detail by the
Salesman and attached to every order. It is
very important that the greatest care should
be taken in the spelling of names, in making
certain that Christian mames are correctly
ae and in furnishing Degrees or Titles,
if any.

 

 

Name

 

Print Ie
Occupation

 

Firm’s Name

 

Business Address

 

Attach Business Card or Letterhead of Subscriber

esidence Address

 

Address for Delivery

 

Town or Cit Province
y

_ Style of Binding

 

Price, $ Terms of Order

 

 

Approx: Age of Subscriber Married?

Name of Bank, with which Subscriber Transacts Business

 

Name and Address of Intimate Friend

 

 

Does Subscriber Own Real Estate? Value
Does Subscriber Have Credit Rating; Dun or Bradstreet?

General Remarks on Credit Responsibility

 

 

 

Salesman