Jardine Miller

Public Library or High School Library Donation Order


(Complete form and print out.)

Yes, I would like to donate a copy of KIRSTIN'S STORY: no place to stand to the Public Library or High School Library listed below. I enclose a cheque/money order in the amount of $10.00 or equivalent and understand that this covers the cost of the book (inclusive of the standard 15% discount allowed to libraries, applicable taxes and postage and handling.

LIBRARY:

ADDRESS:

CITY:

PROVINCE/STATE:

ZIP/POSTAL CODE:

COUNTRY:


(Optional) I would like a book plate attached to the inside front cover. Please select button and type required text in the box:

 

No plate, thank you.

In memory of

On behalf of


Please provide your name and address and we will mail you confirmation and a receipted invoice when we send out the book.


YOUR NAME:

ADDRESS:

CITY:

PROVINCE/STATE:

ZIP/POSTAL CODE:

COUNTRY:


Mail to: JARDINE MILLER, 431 Victoria Street, Shelburne, Ontario L0N 1S4, Canada.


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