Document GKreJO0OzJKE33eVRNYdNxbn4

lOl \ d ut ,w2i ' -iu -tnxi y=gn DEC 18 1986 Pei&tziTH A AbEX fMCTIOS PRODUCTS CROUP E) PERIDENTAL ORDER FORM (Submit 4 Copies) DATE: Dec 16>, I *T _____________ EXPERIMENTAL NO._ /S3</- PROPOSED SHIPPING -H,,. CUSTOMERi Kz^k'AJ&J. \l^r&ZJLter/MtAL- PATE: ' fijl'fj .fS41-1* tQ< Ptefe/s |2b j Ml. ___ SHIP to: Aj? Qis&K/ts_________ P.O. NUMBER;^_ , V;1 3 * . vVW- r; I r ., sk~. ' V-^riTv-j* \ ~ j.'SVt ''f-'j $ '?-- PRINT AATTTTAACCHHEEDD._*___-____*___ _~______ _--____ _*_4_h_.-___i_A__v__-_'__-_#a -~r * .AV **;*: :\ .t-J! V ti`&9r <*s O.K. TO MAKE PARTIAL SHIPMENT //t? -TM**-' ATTN; ft/ZZZ&O Rr-ryJ: /&&=*) HOW SHIP: JSsSS'T'fiJ/? t MO 1X1 QUANTITY J(o 1b / ib !&> fb CUST. PT. NO. ABB PT. NO. 22.^-y--V2-U zz^o-Y-Hz-U i ' FORMULA /0S3-7 ^ y \ S&zi-H ] Jc&z-ii ,\ u>-3-n PRICE a/CAJC- a/<La/cL. a)IL-'f ' A/<T-- /. i KJflTE*4 'T'H&s'C TSe> XXte&~U*ULJJ> &t-J wsr 'TWi&sj /?~gTiJAZjur^xa TV SPECIAL INSTRUCTIONS TEjflCT f^IZ- .ENTER COST ESTIMATE FOR PRODUCTION PART. ESTIMATED ANNUAL USAGE ` '* ) 's-.,rA-% PCS. ' BRAKE APPLICATION DATA: {. f : . j_ [ ! TIPI OF VEHICLE OR MACHINE UO/7P fc&Ftl&MEZjEU MODEL NO. DESCRIPTION OF FRICTION APPLICATION C^&.UTYl ~BRAKE OR CLUTCH SIZE I6> */? X 1 fZar^UUSLO-" F> NUMBER OF PIECES PER UNIT *Jy FZBLOAZj&r ATYPE OP ACTUATION /CL I WET OR PR* OPERATION 7~7g- TYPE 07 TEST 12-1 COMPETITIVE FORMULA m/n APPROVED: Yea or No Has s production quotation been requested? Hake sure periodic sa well aa a final Experimental Report la submitted In reference to this order. * -* \r:^I'*; . V": / SALESMAN SCI 01572