| ITEM ORDERED | CODE No. | SIZE | QTY | COST EACH | TOTAL |
| _____________________________ | ______ | ______ | ______ | ______ | ______ |
| _____________________________ | ______ | ______ | ______ | ______ | ______ |
| _____________________________ | ______ | ______ | ______ | ______ | ______ |
| _____________________________ | ______ | ______ | ______ | ______ | ______ |
| _____________________________ | ______ | ______ | ______ | ______ | ______ |
| _____________________________ | ______ | ______ | ______ | ______ | ______ |
| _____________________________ | ______ | ______ | ______ | ______ | ______ |
| _____________________________ | ______ | ______ | ______ | ______ | ______ |
| _____________________________ | ______ | ______ | ______ | ______ | ______ |
| _____________________________ | ______ | ______ | ______ | ______ | ______ |
| GRAND TOTAL: |
______ |