Quantity 





PRICE 





Amount carried forward 



I 



























































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Total Amount of Order 







(PLEASE DO NOT WRITE IN THIS SPACE) 



Route shipped by , Date shipped 



In Pkgs Bundles Boxes Crates Baskets Bbls. 



The following articles mill be sent later 



Laid out by Checked by Reply required by 



.J937 

 .Bags 



