Form NO 10M 9-50 
>> Please use this order blank for your order 
ORDER BLANK 
CLEARFIELD BITUMINOUS COAL CORPORATION 
DEPARTMENT OF FORESTS 
INDIANA, INDIANA COUNTY, PA. 
Datemee «rte tras eet ats 195... 
SHIDELOE UY CULE ING eee eee i Pe Ue eye NE AR a Strecth seen eo ee 
(Print Name Plainly) 
BOSteOiicer een ween yee Ie SS LAL Cente ee ote. tc COUNTY i eo) ee ee 
Reta DR No eee ee Boxe No. ae ee FERDRESS RO) LICE Rmeecmer Ue meme MON Ee 15", oer CA. aren moet lite ox: Me cots dati lh yer eadios 
Shipiiicalyd Commenter: Reem ee laa t. 0 he EG yeetOgo i aches eLe ose ss, nu hee ee eo Lee, 
(Please Give Approximate Date) (Express—Parcel Post) 
We recommend express on all heavy shipments 
QUANTITY VARIETY OR SPECIE AGE SIZE PRICE PER M EXTENSION 
ToTAL VALUE 
CasH DISCOUNT 
PACKING CHARGE 
TOTAL 
