| Use this form
if you wish to order by mail. Print out this page and fill in the
appropriate blanks, then mail with your remittance to: Frances Rawls,
PRCC Bookstore, 101 Highway 11 N., PO Box 5800, Poplarville, MS, 39470.
Name__________________________________ billing address:
shipping address (if different):
Order items: Merchandise Number_________ Quantity______ Size ________ Unit Price______________ Merchandise Number_________ Quantity______ Size ________ Unit Price______________ Merchandise Number_________ Quantity______ Size ________ Unit Price______________ Merchandise Number_________ Quantity______ Size ________ Unit Price______________ Merchandise Number_________ Quantity______ Size ________ Unit Price______________ Merchandise Number_________ Quantity______ Size ________ Unit Price______________ Merchandise Number_________ Quantity______ Size ________ Unit Price______________ Merchandise Number_________ Quantity______ Size ________ Unit Price______________ Total:
$____________
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