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[[Preprinted Form]]

All articles moved, packed, shipped, crated, stored, serviced and transported subject to the terms and conditions appearing on the back hereof.

W. S. BUDWORTH & SON, Inc., 424 West 52nd Street, New York 19, N. Y.

Call at ^[[J Seligmann N10]] 
[[blank line]] Driver ^[[2]]
4922
for ^[[ ? ]] Collins Dibbs
and deliver to ^[[Corcoran Jury]]

Chgs. on above              $ [[blank line]] 
Excess value or additional             
insurance chg.              $ [[blank line]] 
Chgs. owing                 $ [[blank line]]
C.O.D. - Chg.               $ [[blank line]]     

[[signature line]]
Signature of Customer or Authorized Agent
Received in good order

[[signature line]]
For W. S. BUDWORTH & SON, INC.

[[/Preprinted Form]]