DATE:________________________________

PURCHASE ORDER NO.:________________

SOLD TO:______________________________              SHIP TO:________________________________ _______________________________________            _______________________________________ _______________________________________            _______________________________________  _______________________________________            _______________________________________

ITEM NO.	QUANTITY ORDERED	QUANTITY SHIPPED	DESCRIPTION			UNIT  PRICE	TOTAL AMOUNT
PACKED BY:______________________________________					SUBTOTAL
WEIGHT:  ____________     # OF CARTONS:___________________					SHIPPING & HANDLING
DELIVERY:  _______  PARTIAL:  ______COMPLETE:  ______					__________ % TAX
BACK ORDER #:  _______  DELIVERY BY: ____________________					TOTAL
TERMS:
_________     C.O.D
_________     CASH
_________     CHECK
_________     CHARGE				RECEIVED IN GOOD CONDITIONS BY
_________     ACCOUNT				_______________________________________________