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SEARS, ROEBUCK AND CO.
Kansas City, Missouri 64127
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Sears
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Date_________ 19___
PLEASE BE SURE TO INCLUDE
ZIP CODE
IN YOUR ADDRESS
----------SATISFACTION GUARANTEED OR YOUR MONEY
BACK-----------~·
PLEASE DO NOT WRITE IN THIS SPACE
PLEASE PRINT PLAINLY
All members of the
some
household should order under
one name
NAME._ _____
=----~----,-=-~c----
'F1AsT NAME)
( MIDDLE INITIAL)
(LAST NAME)
Mailing Address•--------------------------
Post Office_____________Slate'-----------=,:::1P'"'c:::o=oe
Te lephone Number
SHIP TO ANOTHER ADDRESS? If you want this
ord ~ r
shipped to another
person or toad ifferent address, freight or express station, give address here:
NAME___________________________
Mailing Address'--------------------------
Post Office____________State -----------,-,P---=-co=--=-oe
IF YOUR ADDRESS HAS CHANGED since last order, please give your old
mailing address here;
Mailing Address _________________________
Post Office,_________ ____State_ _________-::,,-:,P-:c=o-=-=oe
STATE COLOR OR PATTERN CHOICE BY NUMBER ONLY IF REQUESTED
HOW COLOR
COLOR
SIZE
PRICE
TOTAL PRICE SHPG. WT.
NAME OF ITEM
CATALOG NUMBER
MANY NO.
NAME
Measure to be sure Ea., Yd., Pr., Etc.
Dollars
Cents
lbs.
Oz.
--------
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We are required by law to collect tax on sales for : he following states:
Total
I
Total
TOTAL FOR GOODS
Pounds Ounces
If you live In Nebraska or Oklahoma, add 2c tax for every dollar's worth of
goods you order.
---
---
If you live in Arkansas, Colorado, Iowa, Kansas, Missouri, or Wyoming, add 3c tax
for every dollar's worth of goods you order.
AMOUNT FOR TAX
Total
We~ht
If you live in New Mexico or Utah, add 4c tax for every dollar's worth of
---
in Poun s
goods you order.
.
.
. .
If credit order,
---
1 ax rates based on information available at printing and subJect to change.
we will figure and POSTAGE
fill this in tor you
---
Enter Parcel
HOW SHALL WE SHIP?
Post Zone No.
~
Amount I owe Sears
Parcel Post
D
Express
D
Freight (Rail or Truck)
0
on previous order
IF THIS IS AN EASY PAYMENT or MODERNIZING
D
and fill in and sign
TOTAL CASH PRICE
See other side
CREDIT ORDER, CHECK HERE
the form on other side.
tor shipping
--
information
IF A REVOLVING CHARGE ACCOUNT, CHECK HERE
D
Do not send identification
Sears
card or plate.
AMOUNT
Checks
K
MY ACCOUNT
--- ---
At which
ENCLOSED
Money Order
NUMBER IS
Sears Store?
I
Sears
I
26
Recheck to
see
lhor you hove given all informolion such as size, color, pottern, finishes, etc.
or Check
3