Order Form The Blue Rose by Gerda Weissmann Klein,
ALL lines must be filled
in so that your order can be sent.
Last Name _______________________________________________________________________________
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
AMOUNT ENCLOSED: $____.___
Send this form and check or money order to:
THE BLUE ROSE FOUNDATION
P.O. BOX 54
Williamsville, NY 14231
Orders are filled when check/money order has been cleared and deposited.
YOU FOR YOUR ORDER AND SUPPORT!