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W.S. BUDWORTH & SON, INC. 424 WEST 52 STREET, NEW YORK 19, N.Y.

Call at _________^[[JSelegarem]]___^[[2/28/[[2?]]_____________________________
for ______^[['PSF F Gray 
 [[?]]___________________Driver__________[[stamped]]4036[[/stamped]]
and deliver to _____^[[PK]]_____________________________
Chgs. on above $__________ ___________________________________
Excess value or additional insurance chg. $_____
Chgs. owing $______
C.O.D. -- Chg.  $_____

Signature of Customer or Authorized Agent
Received in good order
^[[Bitten?]]
For W. S. BUDWORTH & SON, INC. 

Transcription Notes:
'[[bullet point]]' removed; these are holes for a ring binder