Quantity 



PRTGE 



Amount carried forward 



Total Amount of Order 



(PLEASE DO NOT WRITE IN THIS SPACE) 



Route shipped by Date Shipped 



^" -^^^^ ^""'^^^ Boxes Crates Baskets Bbls . 



The following articles will be sent later , , ." " 



^^'^ o^^h Checked by 



.1933 



.Bags 



. Reply required by . 



