ORDER FORM--Wine of Blindness

(Please print this form and mail to the address below)

Maxine Rosen, Publisher
245 Henry Street, Suite 6E
Brooklyn, NY 11201

Please send me ____ copy [copies] of “The Wine of Blindness” by Eden Vale Stevens. Enclosed is my check for $9.75 per copy plus $3.00 for shipping and handling for the first copy and $1.00 for each additional copy. [For informa-
tion on special rates for orders of five or more copies or on institutional or retailer orders, inquire to info@edenvalestevens.com.]

(New York State residents, please add appropriate sales tax.)

Name ____________________________________________________
Street Address _____________________________________________
                     _____________________________________________
City, State ____________________________________  Zip ________
Amount of enclosed check or money order: $_________

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