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[[Printed form: Application for Domestic Money order]]

Form No. 6001
Post Office Department No. .........
THIRD ASSISTANT POSTMASTER GENERAL Stamp of issuing office
DIVISION OF MONEY ORDERS

The Postmaster
will insert

here.......................
the office drawn on, when the office named by the remitter in the body of this application is not a Money Order Office.

Spaces above this line are for the Postmaster's record, to be filled by him

Application for Domestic Money order
Spaces below to be filled in by purchaser, or, if necessary, by another person for him

Amount
.............Dollars...........Cents
Pay to order of } W. ATLEE BURPEE CO.,
(Name of person or firm for whom is intended)

Whose Address is} No, Burpee Building, Street
Post Office} PHILADELPHIA,
State Pennsylvania.

Sent by .......................
(Name of sender)

Address of sender} No. ..................... Street

PURCHASER MUST SEND ORDER AND COUPON TO PAYEE

[[print vertically on edge of page]] When sending us money use this application. Take it to your Postmaster and procure a Money Order. If not a Money Order office send remittance by registered mail. [[/print vertically on edge of page]]