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I <br /> x 425. <br /> St®n~s ~#ur~®r~o <br /> Eta~t~~~, ~7~r~5 <br /> 3 <br /> E CUSTOMER'S ORDER NO. DEPT. DAT~ <br /> ~rj ( <br /> t / <br /> NAME: e_s _ ~ <br /> ^ <br /> `t Wit` _1 <br /> - i <br /> ADDRESS: ' <br /> ~ _ [ <br /> I CITY, STATE, ZIP <br /> ~ E <br /> ~ k n <br /> i <br /> j L BY: ' CASH C.O.D. CHARGE ON ACCT. MDSE RTD. PAID OUT <br /> i <br /> ~ 9 <br /> QUANTITY: DESCRIP710~] PRICE AMOUNT ` , <br /> r ~ ° <br /> r <br /> S ~ ~ ~ F"7 ~ ~ ~J ~w ~ <br /> t , ~ 7 ~ i. . <br /> J <br /> ~ <br /> ~~""y ~ <br /> 8 <br /> s~ <br /> 1fl - ~ a <br /> f y ~ <br /> <br /> { C 11 ~ C°i] <br /> X. <br /> i2 sQ vm ~,e,~ <br /> 3 <br /> 14 <br /> 15 ~ ~ ~ <br /> . <br /> RECEIVED 8Y ,S ~ <br /> ,j f f <br /> s ' ~ ,,J u` <br /> @ ~ y 3>.w.. r>... m:~:., ss. ~ :mow <br /> KEEP THIS COPY fOR YOUR RECORDS <br /> ©2004 R®1FORM® S13~fl/513205 j <br /> <br />