OCC orrrrccrrocrrrrnrrrrrr nnn ncn rrr hh 
7 7 
NAME TI Date Rec'd qT 
ADDRESS ‘T Amount Rec'd i 
T qT 
I How Paid 7 
‘T T 
‘I Shipped > J 
qT T 
(amrrrrrtcrrorncrrttrrrrrrrerrnin mir k i 
—_ 
Quantity Variety ~ Price 
— 
e 
e ° 
e e 
e * 
e . 
° 3 e 
3 s 
® e 
eye ae eS er eee Ree 
eens oe 
4 © 
e * 
4 € 
: ° 
a ce eR EPO NE A SS A LE ST SS RRS 
4 > 
. e 
e e 
= ® 
rte genera naan ec ERERENeREE NP SE NN TELESALES PS PL IS 
e e 
* « 
® an 
bal 4 
enn cr eR OE Ne AS SS A A SE SS 
is es 
© rs 
s - 
Md se 
aie eta ea al centrereeanqpenenapequnmenn -pvercscreneneny 
* 2 
* ° 
® e 
= ® 
(we See ee 5 ees eee ee es ee ge ee ee 2 ee 
$ ° 
hd 4 
- ® 
s 6 
: ° 
e es 
e 
2 ° 
Total 
Sales Tax 
Postage 
Sm SR Sn ene Se ee 
Amount Due 
REMARKS : 
OE Sp om 
