Iowa Poet Blackie - order form

"Iowa Poet Blackie" - Order Form

Print this page, fill in quantities, mail to the address listed

Name
Address 1
Address 2
City
State
Zip

Qty Description Unit Price Price

___ Book of Poetry $20.00 _________

___ 2010 Calendar (available spring) $10.00 _________

___ 2009 Calendar   $9.00 _________

___ 2008 Calendar   $8.00 _________

___ 2007 Calendar   $7.00 _________

___ 2006 Calendar   $6.00 _________

___ 2005 Calendar   $5.00 _________

___ 2004 Calendar   $4.00 _________

___ 2003 Calendar   $3.00 _________

___ 2002 Calendar   $2.00 _________

___ 2001 Calendar   $1.00 _________

___ 2000 Calendar   $2.00 _________

___ Bumper Sticker   $2.00 _________

___ Refrigerator Magnet   $2.00 _________
Total Price _________

Please send donation plus postage (money order) to
"Iowa Poet Blackie"
Post Office Box #487
New Hampton, Chickasaw County, Iowa 50659

Qty	Description	Unit Price	Price
___	Book of Poetry	$20.00	_________
___	2010 Calendar (available spring)	$10.00	_________
___	2009 Calendar	$9.00	_________
___	2008 Calendar	$8.00	_________
___	2007 Calendar	$7.00	_________
___	2006 Calendar	$6.00	_________
___	2005 Calendar	$5.00	_________
___	2004 Calendar	$4.00	_________
___	2003 Calendar	$3.00	_________
___	2002 Calendar	$2.00	_________
___	2001 Calendar	$1.00	_________
___	2000 Calendar	$2.00	_________
___	Bumper Sticker	$2.00	_________
___	Refrigerator Magnet	$2.00	_________
	Total Price		_________