FRIENDS OF THE SELINSGROVE COMMUNITY LIBRARY

SELINSGROVE SPEEDWAY CROCK 2010 ORDER FORM

Please print this web page form

# OF CROCKS ______ @$40.00 EACH  =__________ DATE ______________

PLEASE PRINT

NAME ___________________________________________________________________________________________

ADDRESS ________________________________________________________________________________________

CITY/STATE/ZIP____________________________________________________________________________________

PHONE _____________________ EMAIL_____________________________________________________________

I Will Pay By
CHECK # ________ CASH _________ PAY AT PICKUP _______________

MAKE CHECKS PAYABLE TO:  FRIENDS OF THE SELINSGROVE LIBRARY
                                                P.O. Box 112
                                                Selinsgrove, PA  17870

PLEASE MAIL TOP PORTION OF ORDER FORM TO THE ABOVE ADDRESS
OR DROP OFF AT SELINSGROVE LIBRARY

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RETAIN THIS PORTION OF FORM FOR YOUR RECORDS-BRING THIS RECEIPT TO PICK UP YOUR CROCK

SELINSGROVE SPEEDWAY CROCK 2010 RECEIPT

# CROCKS ORDERED ______________________ DATE ORDERED ___________________________
$40.00 Each  = ___________PAID ___________ CASH __________CHECK # ___________________
PAY AT PICKUP _____________

NAME ________________________________________________

MAKE CHECKS PAYABLE TO FRIENDS OF THE SELINSGROVE LIBRARY

YOU WILL BE CONTACTED WHEN AND WHERE CROCKS WILL BE AVAILABLE FOR PICKUP
BRING THIS RECEIPT TO GET YOUR CROCK