Name:
 
Address:
 
City:
 
Zip Code:
 
 
 
 
 
State:
 
 
Phone:
 
E-mail:
Local Retail Outlets
 
Village Books
1200 11th Street
Bellingham, WA 98225
800-392-BOOK
www.villagebooks.com
 
Maple Fuels
7797 Silver Lake Road
Maple Falls, WA 98266
360-599-2222
 
Northwest Treasure Supply
4145 Bakerview Spur
Bellingham, WA 98227
360-733-5750
www.nwtsdetectors.com
 
Baker Bear Grocery
1706 Mt. Baker Hwy.
Bellingham, WA 98226
360-734-3000
 
Graham Store
9989 Mt. Baker Hwy.
Deming, WA 98244
360-599-2665
 
 
 
 
 
 
Please Print Order Form and Send to:
Shirley Dias
2323 Moore
Bellingham, WA 98229
Phone: 360-733-4308  Email: sadlen65@msn.com
Method of Payment
 
The Book The Lone Jack Quantity Price Each $24.95 Total
 
WA State Sales Tax 8.4% Shipping & Handling $6.00 Each Grand Total
 
 
 
 
 
 
MasterCard
Check/Money Order (Included)
Made payable to Shirley Dias
Visa  
 
Account #
Expiration Date
Cardholder’s Signature: