1930 Newton County, Arkansas

Census Order Form

  

 

 

Name:

 

Date:

 

Address 1:

 

Email:

 

Address 2:

 

 

 

City:

 

 

 

State:

 

Zip Code:

 

Phone # (optional)

 

 

 

 

Name:

 

Date:

 

Address 1:

 

Email:

 

Address 2:

 

 

 

City:

 

 

 

State:

 

Zip Code:

 

Phone # (optional)

 

 

 

 

Name:

 

Date:

 

Address 1:

 

Email:

 

Address 2:

 

 

 

City:

 

 

 

State:

 

Zip Code:

 

Phone # (optional)

 

 

 

 

Printed format Quantity:

 

x $45.00 (includes shipping costs)

Total:

 

CD format Quantity:

 

x $15.00 (includes shipping costs)

Total:

 

 

 

Mail to:

Carri L. Holt

 

 

P.O. Box 867562

 

 

Plano, Texas 75086

 

 

 

 

 

Make check payable to:  Carri L. Holt (Please include this Order Form when mailing check).  If ordering more than 3 books or CD’s, please provide name and address so I can ship the book directly to them, saving additional shipping charges on your end.