Mail to:
Gorin Genealogical Publishing,
205 Clements Avenue, 
Glasgow KY 42141-3409


Your Name _________________________________________________________

Address ___________________________________________________________

City ______________________________________________________________

State _________________________________ Zip Code __________________

Email Address _____________________________________________________

Phone # (__________) - ______________ - ___________________________


Items Ordered:

____________________________________________________ $ ____________

____________________________________________________ $ ____________

____________________________________________________ $ ____________

____________________________________________________ $ ____________

____________________________________________________ $ ____________

____________________________________________________ $ ____________

____________________________________________________ $ ____________

                                            Subtotal $ ____________
                          
                       6% KY Sales Tax if Applicable $ ____________
                                
                                               Total $ ____________