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________________________________ SAME AS SOLD TO UNLESS OTHERWISE INDICATED HERE DATE YOUR ORDER NO. OUR ORDER NO. QUANTITY ORDERED QUANTITY BACK. ORD’D. u ORDER COMPLETE u BALANCE TO FOLLOW QUANTITY SHIPPED SHIPPED VIA CTNS. PKGS. TOT. WT. DESCRIPTION PLEASE NOTIFY US IMMEDIATELY IF ERROR IS FOUND IN SHIPMENT. PACKED BY _______________________________ CHECKED BY _________________________ FORM #40B .

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