NUMBER 



ARTICLES 



Amount brought forward, 



PRICE 



Total amount of order, 



(Customers wili please not write in this space.) 



Route shipped by _ Date shipped _ 



i8Q4. 



1,1 Pkgs.; _ Boxes; Baskets; Bbls.; Bags; Bundles. 



The following omitted articles will be sent 



Laid out by _ ; Checked by ; R e p]y required by 



