Order Form
Carleton's Loyalist Index
and The Book of Negroes

Order #	_______  Date Order Received  __________________

Name:  _________________________________________________


Address: ________________________________________________


City: ____________________ State or Province: ____________


Country: _________________ Postal or Zip Code: ____________

E-mail address: __________________________________________

Costs:	Canada, $25.00 each + $2.50 S & H
	Other countries, $25.00 U.S. each + $2.50 U.S. S & H

The Index is provided in Adobe PDF format for PC or  MAC, on CD-ROM.

Number ordered    _____    x $25.00  = $_____________

Shipping Charges  _____    x $ 2.50  = $_____________
 
			  Total Cost   $_____________

Make payable to: Sir Guy Carleton Branch, UELAC

Mail completed order form and payment to:
Edward Kipp
Sir Guy Carleton Branch
United Empire Loyalists' Association of Canada
6242 Paddler Way
Orleans ON K1C 2E7 Canada

Note: A database version of Carleton's Loyalist Index and The Book of Negroes is available on request.