NAME: __________________________________________________________
ADDRESS: ______________________________________________________
_________________________________________________________________
PROVINCE/ STATE: ________________ COUNTRY: ____________________
POSTAL CODE/ ZIP: _____________________
ITEMS:
_________________________________ # _____________ Cost: _____________
TOTAL COST: ________________________________
(Canadian Taxes are already included in the Price)

The Rev'd John G. Pearce
(Telephone: 1 506-785-4616)
140
Brown's Yard Church Road
Brown's Yard, NB, Canada
E4T 1W8