North Carolina Laws
				for
	Animal Control – Animal Protection – Public Health



			    ORDER FORM
      
Date:_________________	       Purchase Order Number:_______________

Name/Title:_________________________________________________________

Agency/Organization:________________________________________________

Mailing Address:____________________________________________________
		     Number & Street  P.O. Box
____________________________________________________________________
City	     	  			State  		Zip Code

Shipping Address:___________________________________________________
		     Number & Street  P.O. Box
____________________________________________________________________
City	       				State         	Zip Code

Telephone:(______)________________________

E-mail: __________________________________@_________________________

Comments:___________________________________________________________

____________________________________________________________________

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Text price:					$28.00/each
(Tax & Shipping is included)
Total Order.............$28.00/each  X    ____________ = $____________
				           Number ordered   Total Amount

Please remit full amount with order. 
Check, Money Order, Certified Check, Government Purchase Orders

Please send order form and payment to:
				
				Elma Rae Greene
				P.O. Box 123
				Mebane, NC  27302
 Thank You!