ALWAYS USE THIS BLANK WHEN SENDING IN ORDERS.

Three Months' Subscriptions cost 5 cents more than 1/4

and Six Months' Subscriptions 5 cents more than 1/2

the price to Agents for one year.

D. D. COTTRELL Periodical Subscription Agency, NORTH COHOCTON,

N.Y.

_Make all drafts or money-orders payable to D.D. COTTRELL, North

Cohocton, N.Y.

[Note that The D. D. COTTRELL company NO LONGER EXISTS!!!]

Personal Checks are accepted without any charge for collection. Remit at

least twice each week, if possible, as it will save complaints from your

subscribers.

Be careful to fill in this blank according to the printed headings.

Write plainly and keep a copy of order. Write New or Renewal in Old or

New Column_

Your Consecutive

Order No._______________________ (Date)___________ 190_______

From ________________________________________________________

Street Address ______________________________________________

Post-Office _______________________ State ___________________

_In above space write only name and address of remitter,

to whom a receipt for money will be mailed._

[Transcriber's note: the following is a 12-line order blank--the headers

are a single row.]

Old or New | SUBSCRIBER'S NAME | STREET ADDRESS | POST OFFICE | STATE |

Names of Periodicals Wanted | When to Begin | How Long to Send |

CASH $ Cts. |

1

2

3

4

5

6

7

8

9

10

11

12

HARPER'S MAGAZINE--THE GREAT LEADING MAGAZINE OF THE WORLD--[$4.00 A

YEAR] SEND ME ONLY $3.35 OR ADD $3.35 TO ANY ORDER.

When you are out of these Blanks, advise, and we will mail new supply

free

[The following order for Harper's magazine was on the back of the

above subscription form.]

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