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<br /> ,. �•�- OATE ;��G��1 No. 12 4 3 01 � • �.....
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<br />�:�: � • � � .. CASH........ ❑ �R CHARGE,bXIStINGACCOUNT q►�
<br /> F s •:�' SALE AMOUNT.......... ...........•Blll.NEXT 9�LL ❑ CHARGE,NEYV ACCOUNT...AUTHORIZE���i_1...
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<br /> ,y ' , DOriN PAYMENT...REQ�LL��T.PD. CUSTOMER DESINED MONTHLY PAVM6NtAMOUNT�— c
<br /> ' ' • QUANTITY STOGK ACCT. A�CTE COST AMOUNT OF SALE �1.��
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<br /> " � :;;1''�1`••�. SUMMARY OF STQRES ACGOUNTS SUB TOTAL 19 `'' , � _
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<br /> • sj:,�.!tf�S".l.t: ';.; NO. ACCT.NO. REMMAOUNT � . �
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<br /> � '����� ��y��p���,,. ORiGINAI COPY
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