Please print this form and mail it with your personal check or money order payable to Tom Perry.

                Tom Perry

                P. O. Box 50

                Ararat, VA 24053

Books                                                                   Quantity

The Free State Of Patrick  $24.99                         ____ 

Ascent To Glory $14.99                                          ____

Stuart's Birthplace $24.99                                       ____

God's Will Be Done $14.99                                        ____

Images of America: Patrick County $19.99                _____

Order Total                                 ________

Virginia Sales Tax 5%                 ________

$5 Shipping Per Order                ________

Total amount enclosed             $_______

Customer Information

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THANK YOU FOR YOUR ORDER!

PLEASE BE AWARE THAT THESE BOOKS ARE SOFT COVER.

THESE BOOKS ARE PRINTED ON DEMAND EXCEPT FOR IMAGES OF AMERICA.

YOUR ORDER WILL NOT BE PRINTED UNTIL PAYMENT IS RECEIVED.

PLEASE ALLOW 3-4 WEEKS TO RECEIVE YOUR BOOKS.