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P/LYMENT ORDER BLANK ~ ~
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Interrie.er ~f Sa~n. tNrllc4 M~ G. TAlh 1~ w M-M.NNMs e~~r~111~ 4
i1. NMr M~w flNq w~wltaw~l iN~r ~IIOtAN I~~N iw wiNwl• ~ i
- RETAII tNSTAtMENT - C O;itONAI S CONTRACT ~ 3
~rARS, ROFSUCK ond ~0:~~~__ ~.Ooh ~'"l Y'~ O f7 _19 Gb
. A~eey ef $OOre ~iu~4er. CiV S1att~ - \
I hereby order the following merchandise:
QIYISICII \ OESCWf10i
i ~
f
S ~
0 ,
S' 3 f ~
Ly ;
~
~ OOC. TAX 5
~.•ars, Roeburk aed Co.: '
~ ~9-~js-- r ~ as~ rrc~ s
!~rcinnin ~t ~ ~ and oa the aeme date for_ wcccssi~c months~ I rrill a ~ ~
S~~_ monthlr (last paYmrnl mar ran sligh~lrl until the balance on mr Easr Pay- _ _
~~t~n~ account tor merchaadise hereb~ otdercd has-been paid. llntil such paymeat has beeo made. I r
,_r~.• that: You shitl retain title to and riaht of p~~e~~~on of said mcrchandix; l will not sell, remore. C+sa9+~+~ce '+'1'a` -
.~r rncumber i~; I shall be rrspuosible (or all loss of or damase to +aid merchandise• anJ, i[ t should de- ~
i,~~it in any {arment or payments, you ma7. at your option, take b~k the merclwndix or a(liriu the f" ~ ~
snd hold me liable (or ~he unpaid balance on m~ account. tree~t?ria ~
NOTICE TO BUYER: 1. Do_ not si n this a r~amfnt b~fore rou reod it or if if contans anr 9~
8 9 CrNit Mitt ~3 j~ =u~iic
blank spac~. 4. You an entitl~d to ~~xact copy of thts agreement. 3. You hov~ th~
:ig6t to po~? in advar~es tht full amowet dw and und~r e~rtayp eonditions to ob a' 3
partia! refw~d of t odd~d for 't price. ~ ~ ' -
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CU570MER'S S16NA -
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AODRE55
A~ 1vI'~D- ~ F1AST [%I~
C~YY ~~rI V~~~ 20NE STAT rAYMENT 6Y~ -
h' ~ME
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R NT/- -V-f/--S~-i~P-~ G ~~~IL/O~ H M
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FINST INITUL ~ LASi - ftRST A1tl~0YM pAT~
HOW LONQ AT -
PR~SENT ADORE557 OWN DIREN! O ~MO Q rMON[NO MARRI[O Q SIHGIE Q ~
P^RMER A001lESS (IF LESS TMA HOW
~ 2 YRS. ATlI~ESEIVTADDNE59 LOMOi AO~ DErEMOENTI.~ _ ~
EMPL.7Y :
TIME GARO Oll MO. p
FSOW LONOt OCCVrAT10N1~ ~AOOE tlO.t EARMINOS ~ w~r. p
FJRMER EMrIOYER lIF LESS TMAN ` 1~ ~6t
t vR. WITM PRESEtIT EM?IOYERI ~_T~~
CHECKINO ?
!:AME ANO AO"RESS OF SANX ~ ~ SI?N~VBS ? ~
LOµ a 1AEYIOUS S RS ~CCOUNT
EYP~~AIH OTMER iNGOME. iF ANY EP SRC
NAME ANO ADOI~ESS CREDIT REFERENCES MAME ANO AOORE55 ~
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OrEN OIEN ACCOUMT HO. ~
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F'Ll Iq TMESE SPAtES OB PURCMAStS Of FURNIICES. NEATtNG PIIyTS, PIUMBtl1G EQUIVYENi. lNS111l1E0 CARiET1AC. EIECTRiC FUITURES, CREOIT
CQ4FlNQ OR YAIAi. ON TNESE PURCXASES E RESERYE *ME RIGIIT i0 F wECMANICS l1EN.
ir.atM M K~rl~ Y~Jd ~Yrol b Y M iM~Y ~~~C f /'~/1 ?~SEIiT tAL.
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~~T~ ~ ATE GLOSED _
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NO. rMTS. J , .
G,ll ~N iNESE S~ACES IF PYRCMASER IS fARMER: BOUK PAGE Z~z ~'~U~ r
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