Besancon Historical Society = Publications Order Form

Publications

Please fill out the following form and return with your remittance to the address below

Publications Order Form Name: ________________________________________________________________________ Street or Box No.: _______________________________________________________________ City: _______________________________State:_____Zip:______________________________ Telephone No.: ( ____) _________________E-mail:______________________________________
Description of Item	Quantity Desired	Price Each Item	Price Total
Photo of Interior of St. Louis Church		$5.00
Photo of Exterior of St. Louis Church		$5.00
Windows of the Past		$7.95
Back Issues of Besancon, Indiana Chronicles Indicate Issue Number(s) in Quantity Desired Column		$4.00

Total. Add purchases and place amount in the next column.
Indiana residents: add 5% sales tax to total.
If your have purchased Chronicles issues and/or Windows book add $3.50 S & H for each item.
TOTAL

Besancon Historical Society
15535 Lincoln Highway East
New Haven IN 46774