Proposition for local agent, correspondent, etc.

Name………………………………………………………….

Address……………………………………………………….

Occupation…………………………………………………….

If a Soldier, what Corps?……………………………………….

If not a Soldier, what Denomination?……………………………..

If spoken to on the subject, what reply they have made?…………….

……………………………………………………………..

……………………………………………………………..

……………………………………………………………..