Ship to 
Care of 
P. O., St. 
or R. F. D. Address 
Freight or 
Express Address 
County State 
Mail Freight Express Boat Parcel Baggage 
Post Master 
ORDERED BY FILLED BY D. CHECKED BY 
Date Date 
DLR. WH. TER. 
CHECK 
COLUMN QUANTITY DESCRIPTION 
Check or M. O. Enclosed $ 
Charge to 
Address 
Notify 
Local Deliver To Call 
Express 
PACKED BY NOTIFIED 
Date 
PRICE 
UNIT TOTAL 
