E. James Small
150 MacLaughlin Ave.

Lower Onslow, Nova Scotia,
Canada, B6L 5G6
Name:_____________________________________Date:_________________________
Address:________________________________________________________________
City:___________________________ State/province:________________________
Country:____________________ Postal Code:_______________________________
Email address:__________________________________________________________
Phone No. and best time to call (optional):_____________________________
              
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                                   Total $ enclosed/sent:_______________
Please mail this order form along with your payment to the address shown above.

PAYMENT MUST BE MADE OUT TO "JAMES SMALL"

Thank you for your order.  Please allow six to eight weeks for delivery.