Report LS,. MP SANITATIO-14 F.. VICES
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(-CUSTOMER'S ORDER NO. PHONE DATE �/ ,! 1
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NAME ,l 1/
ADDRESS1 `, /� • {/�
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SOLD BY CASH C.O.D. CHARGE) ON ACCT. MDSE.RETD. PAID OUT
QTY. DESCRIPTION PRICE AMOUNT
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a h, charged • :,paid baiaa::ces TAX riv
RECEIVED BY TOTAL rci.
All claims and returned goods MUST be accompanied by this bill.
L„ J ^� �" `Thank`You
80)-22'2 r3N30 netr.;