Title:____________________________________________________

Quantity__________

Price:____________      (Less 10% Member's Discount, if Applicable)
                                        (Please Provide Your Membership #_______)

Shipping and Handling_____________

Total Cost: _____________________

SHIP TO:

Name:_______________________________________________________________________

Street Address: _______________________________________________________________

City: ________________________________________   State: _______   Zip: ____________

Country: _______________________   Telephone: __________________________________
 

                                         Mail  to:  Passaic County Historical Society 
                                                          Lambert Castle, 3 Valley Road
                                                          Paterson, NJ  07503