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COMMUNICATION PRODUCTS DEPARTMENT
CPD 100 (6-68)
CUSTOMER'S
REQ'N. NO. CUST. ORDER NO. GENERAL ELECTRIC
PURCHASE ORDER
COMPANY
2 CUST.
NAME
MOUNTAIN VIEW ROAD
LYNCHBURG, VIRGINIA 24502
DO NOT USE SHADED AREAS
STREE1 STREET CUST. ACCOUNT NO. CLASS
TAX CODE HOLD WK. SCHED
STATE ' ZIP CODE MARK CITY COUNTY S. S. CODE BILL CODE COUNTY STATE
ATTN
COMBINATION, OPTION OR OPERATING FREQUENCY TOTAL
DRAWING NUMBER TRANSMITTER RECEIVER AMOUNT
COPY
BILL PARTIAL DEPOSIT TOTAL EQUIP. PRICE
IF TRADE-IN INCLUDED, ATTACH SALE (SEE PARAGRAPH 5 REVERSE SIDE HEREOF]
BILL LOT
TRADE-IN EQUIPMENT APPRAISAL FORM (CPD 372) LEASE )S. 8. $ S______________________
CUSTOMER OR FIRM NAME UNPAID BAL INSTALLATION / attach all \
COND. SALE \ QUOTATIONS )
OTHER $ $
SHIPMENT REQUESTED COLLECT 1RANSP. CHGS.
PREPAID ~ BILL TRANSP
o PREPAID TRANSP. INC. $
MR SIGNATURE LOCATION 2 SHIP INSTR. CUSTOMER HOLD FOR LICENSE CLASS OF SERVICE NEW SALE TAXES
5 REPLACEMENT
0 BOOKS TO; SHIP TO YES NO .□ ADD TO OLD SYSTEM $___________________
DSM TOTAL TIME PRICE TOTAL SALES PRICE
THIS ORDER IS SUBJECT TO WRITTEN ACCEPTANCE BY THE COMPANY AT
LYNCHBURG, VIRGINIA, AND TO CONDITIONS PRINTED ON THE REVERSE SIDE 3 7, S Z
$
