Order No...............

Mr...................................

Address.............................. Date..................19....

Please ...................................................... Building

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EMPLOYEE: Enter Mechanics time, and material received on this order, sign and return at once.

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..........Mechanic.......Days.......Hrs.

..........Helper.........Days.......Hrs.

Overtime, Mechanic.......Days.......Hrs.

" Helper.........Days.......Hrs.

Signed ...................Days.......Hrs.