Order Form
The Pennsylvania Colony of Nebraska Historical Society

Fill out, print and mail this form.

Date <--- Start here then press Tab to go to next BOX

From:
Name:
Address1:
Address2:
City, State, Zip:
Phone:
Email address:
Ship Order To :
 
 
 
 
 
 
 
 


Product
Qty
Unit Price
Ext Price
*Price includes shipping and handling* Total:



Make Check Payable to: Pennsylvania Colony of Nebraska
 Please submit your payment in full with this order form to:

Pennsylvania Colony of Nebraska
71329 638 Ave.
Dawson, NE 68337

Sorry ... No Credit Card orders at this time. Please allow two weeks for Delivery
Last updated 1/4/07