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I <br />t <br />i <br />f <br />'357950 <br />CUSTOMER'S ORDER NO, <br />DEPARTMENT <br />DATE <br />� <br />NAM <br />ADDRESS <br />CITY, STATE, ZIP <br />SOLD BY I <br />CASH <br />C.O D. <br />CHARGE <br />ON ACCT. <br />MDSE RETD <br />I PAID OUT <br />QUANTITY <br />— d KSQRIPTION - <br />PRICE <br />AMOUNT <br />1 <br />+ <br />6 <br />2 <br />DATE <br />AIRHORIWION'. <br />[ <br />SUB <br />TOTAL <br />rL <br />3 <br />REOAEPT <br />TAX <br />FOLINCHECK NO. SERVER CLERK <br />} <br />SALES SLI �` <br />4 <br />5 <br />6 <br />7 <br />8 <br />I <br />9 <br />10 <br />11 <br />12 <br />13 <br />14 <br />15 <br />16 <br />17 <br />1• <br />19 <br />.. <br />20 <br />6 <br />RECEIVED BY 1 , <br />wma I KEEP THIS SUP FOR REFERENCE ° <br />5805 <br />l r .iF <br />0 4/_ 1 3;` °'`' <br />JANE X'CR AER <br />{ r 02, 152 <br />!, a� rt <br />I t <br />$ 345,907 'l561iit +I <br />S::JtPE'AHC�S'AYE 1 <br />AL.V�A0O'RE ,I 0R <br />S j .• C. 9:. i' � P c _t I I � <br />PLIJ CHAS SIGN ER <br />X � <br />Cardholdpf ecknowbdgea receipt of goods andfor services In the <br />amount dl the Tatel shown hereon end agrees to perform the <br />obligati sam forth in the Cardholder's agreement wlth°tha lsswr. <br />i <br />., . 32 <br />OUAN <br />CLASS <br />_ " DESCRIPL "+ <br />"PRICE <br />'' AMOUNT <br />DATE <br />AIRHORIWION'. <br />SUB <br />TOTAL <br />° <br />REFERENCENO.' <br />REOAEPT <br />TAX <br />FOLINCHECK NO. SERVER CLERK <br />} <br />SALES SLI �` <br />01 <br />U.1 <br />f!l <br />i <br />i <br />V, IMPORTANT: RETAIN THIS COPY FOR.YOUR RECORDS ` <br />sj <br />