IN De 5035 4FTX5OFT WI/63/ / 3.00 20.00 35.00 W1154/ / 25.00 3.00 5 Lines Total *Lines Not Printed 0 Amount Total: 5078.16 'eked By: Chocked By: Delivered By: Condition of Material ustomer Signature: Date Received: 18.00 3.00 ROLL 103.98000 1871.64 458.76; J i PL 152.92