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N ~ a, <br /> a m <br /> m <br /> N <br /> M i <br /> No. <br /> ~ DATE <br /> ~ ~w <br /> j~ ORDt=(~ NO. <br /> 'r <br /> OI <br /> i ~ <br /> i~ NAME <br /> °o V`:~ ADDRESS <br /> ya <br /> ~ ~ ~`1 (~c~~ ~ ~ <br /> SOLD BY C.O.D. ~ PAID OUT <br /> I ~ ~ CASH <br /> ~~jj z ."i. ~ ~ ~ CHARGE ~ MERCHANDISE RETURNED <br /> L o <br /> E <br /> ~ <br /> ~ Z S t/' <br /> ~ g5is,~ <br /> ~ ~ <br /> a <br /> w <br /> m .J/ 1....+ <br /> W -Y- v <br /> Q <br /> O C? L"'7 <br /> i ~ Z ~ <br /> Y W <br /> i ~ _ ~ <br /> Ul l7 <br /> U <br /> ~ M- <br /> 1--1 <br /> N I <br /> x w <br /> V <br /> W C7 H {x-. <br /> 1 <br /> Q <br /> ti - ~ ~ <br /> /`7 O <br /> Q <br /> li <br /> F ~ w <br /> H <br /> o Oa <br /> .~y~~ <br /> C~ <br /> h <br /> ~M ~ ~ a': O <br /> n ~ d Z W <br /> o ¢ 2' O <br /> [L <br /> Xp _ Q .U=O. <br /> om~ ~ ~~o <br /> a.w z ~ <br /> o ¢ m <br /> r-- ° <br /> z <br /> a: <br /> _ . , CiAdams <br /> <br /> ~ <br /> Nczea~ SIGNATURE <br /> ALL CLAIMS AND RETURNED GOODS MUST BE ACCOMPANIED BYTHIS BlL! <br /> GE <br /> NERAL PURPO E <br /> S <br /> ~'°Q~# <br /> <br />