sHiP BY_| Charge Date Wanted Our Order No,
FORM NO, 194 }

KANSAS CITY |. = rea

ORDER BLANK

FGT. Customer’s Order No.

CHECK ONE| Ship To

OWE & Chup. BELL : y Ax Date Received

ATHLETIC GOODS Co. d
1509-11-13 BALTIMORE AVE., KANSAS CiTy, Mo. | ©-9-D.

STOCK PRICE PLEASE DO NOT USE
Pa o ARTICLE—EXACT COLOR SHADE—SIZE

NO. EXTENSION THESE COLUMNS

QUOTED PRICES ARE SUBJECT TO ACCEPTANCE BY OFFICE

TRANSPORTATION &
INSURANCE CHARGES ae

Total Amount Remitted $

Ordered
ORDER PLACED By ACKNOWLEDGED

BY
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PLACED AT. Approved

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SHIPPED FROM