ORDER FORM 
FLORIDA BULB COMPANY 
P,. O. Box 49 DuPont Building 
Miami 1, Florida 
Date______ 
Ship to: 
Street Address: 
City: 
Date of Shipment: 
["] Remittomce Enclosed.__ ee 
[] 25% Remittemce Enclosed] see 
Balance C.O.D. 
[] Charge (to customers with established credit) 
Quantity Variety Amount 
Te a 
ee | | ee 
| A | 
a a | | 


