Book Order Form     The Blue Rose by Gerda Weissman Klein, 2008 edition
ALL lines must be filled in so that your order can be sent.
   
First Name _______________________________________________________________________  

Last Name _______________________________________________________________________________ 

Address     _______________________________________________________________________________ 
   
City         ________________________________________________________________________________

State        _________

Zip Code    ________________

(Orders are only accepted from and only sent within continental U.S.)
   
Email address ______________________________________________________________________________ 

Phone number ______________________________________________________________________________ 

Put an "X" after the number of copies you are ordering.

1 copy      ________             Cost is $15.00

2 copies    ________             Cost is  $30.00

3 copies    ________             Cost is $45.00

4 copies    ________             Cost is $60.00

If ordering more than 4 copies, fill in the number and the correct total by multiplying the number of books by $15.00.

Number of copies_________    Total Cost  $_____    

CHECK OR MONEY ORDER: PAYABLE TO THE BLUE ROSE FOUNDATION
Only checks with printed name and address will be accepted.

AMOUNT ENCLOSED:  $____.___