WANT LIST FORM

O. E. "DUSTY" ROYER
34 LAKE CHARLES
ST. PETERS, MO 63376
dustyib@netscape.net

 INSTRUCTIONS: You may print this form and send the completed form to the above address. Or, you may send your want list by e-mail by including all of the information set forth below. Either way, I notify you if any material you are looking for is found. You are under no obligation to buy until you place an order.

NAME:

 

ADDRESS:

 

E-MAIL ADDRESS:

 

DATE:

 

CATALOG #

COUNTRY/STATE

DENOMINATION

DATE/YEAR/TYPE

CONDITION