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� <br /> f <br /> r. � <br /> -, ; . <br /> , <br /> ��bl� order torm ' <br /> f1 f C I ,� IJL.i Planned MerchandEal�g Equlpment i`:� <br /> � "n"Dealer andor D�stnw;or • <br /> � �' � <br /> Inte�nally Illurr�tnateci Pri� Sign ' <br /> Stenderd Version unu cos� ocy �o�ei cos� <br /> Product Cods Slzs For <br /> . Single Pols I S-1-�'-�.t�."- <br /> 39208•4 A 12' 1 D Pole 516G0 S <br /> 39207�f'i • B B' 1D Pole 3t600 <br /> Twln Pole �2' 1D Pole s�� � <br /> 39213•4 A $ <br /> 39212•8 8 8' 1D Pole $��� <br /> Calltomla Ve� <br /> 311p1� PON 12' 1D Poie S1fi�0 $'�— <br /> 39208�4 A $ <br /> 3920&2 B 8' 1D Pole 51600 <br /> Twin Pols �2' 1D Pole $�s� $ <br /> 39215•9 A 5.---- <br /> 39214•2 B 8 1D Pole g�s� <br /> � , g IG�Od. ��, <br /> Subtotal............................................................................................................ ................................. <br /> ,� c. <br /> . .. . . .. . £���s5' G <br /> ..... ..... ........ . <br /> Tax........................................................................................................ ............. <br /> Total................................. ...................................... <br /> ...... ... ......... . <br /> ..... . <br /> Note: Mobil pays for shlpPinp to one(1) locetiort 4a�;:T�°�` '+ ��'��'�••� t�� ���'t��lipn A Sa'o �n� APhP�h�ep <br /> Agreement must be signed at the tlme ot p�«�� •' <br /> Distrlct '�^ n-C►���F" S"T — <br /> :,r h�raiationNo. �.� -I Z�_- <br /> Customer Account No. s 3��^�� �' � " <br /> ShiP to:_ . la_ � �V• fl . . t�SCO ------ <br /> Address 2 D� •�,•� `C5 4v� - <br /> Cfty,Slete821p •V . T �A. q� ZO� <br /> Telephone Number. Area Code(�'1 2 S y ' ���--9'-- / <br /> Mett� Payment C�eck 0 Net 30 Days ❑ 30•60•9� Days ❑ <br /> �o !�1 Ci nlY�a 5 Y <br /> Credit/wthorization No. <br /> C-z.te43 KS _ <br /> CustomerSignature • ��"��Date �� <br /> L, �f � Date �� �'9 � <br /> Marketing Representative Signature <br /> WhHe- Oriqina�to C.A.ihomes—Faidaa Otlice <br /> � YBIIOW- SeconO topy lo C.A.Thotn�s—Fnlrtax 011icx <br /> Pmk- Tnird copy to Distdci 01fice <br /> G^Idenrod• Fa:rth copy to Custemer <br /> l .j <br /> F <br />