PACKING SLIP
BROCK TOOL COMPANY
NUMBER
DATE
R-
1401 E. RIVERSIDE DR. INDIANAPOLIS, IN 46202 Ph. 317.634.7575 Fx. 317.636.0588
DATE SHIPPED
SERVING INDUSTRY AND CONTRACT ORS
ACCT. NO.:
SHIP VIA
CUSTOMER ORDER NUMBER
TAKEN BY
MANUFACTURER
PER P/C 0 9 6 19PARTS 288 377 46DISC. 555 644 73 3 2 82LABOR 911 090 189 278 367 45 6 0 545 634 723 812 991 01 80729 0 09 98 87 76 54321 5 4 3 20190897854321 79 6 5 4 3 2 1 06 95 84 73 38 47 5 7 8 9 82 7 6 5 4 3 2 1 0 9 8 7 6 5 4 3 2 1 0 9 8 54321 0 9 8 7 54321 0 9 8 7 54321 0 010 29 38 47 5654 83 92 010 29 38 47 565 74 83 92 097 61850 38 0 9 8 7 54321 5 4 3 2 1250349438052796168705789454321 2749 354321 4 27 5 16 0 79 88 97 016 98307216125 40 95 0 9 8 7 54321 2 1 0 9 8 3039 4928 5817 6706 754321 8 84 9 73 06 15 24 33 42 5 17 6 06 7 95 8084 9973 0862 1751 2 40 33 29 18 0 9 8 7 54321 5 46 3 224 133042951806079796885797454321 454321 5 07 6 96 78 87 015 0631522413300429951 08 75 20 0 9 8 7 54321 23 1 0 9 8 6897786 854321 9 64 0 53 14 32 41 50 6 97 86 8 75 9064 0953 1842731 354321 4 19 5 08 69 87076 74354321 0 9 8 7 54321 969 878 787 696 5054143232032194108509769878787 8965 9854 01 23232141050 66 55 00 0 9 8 7 54321 2 1 0 9 8 954321 0 44 1 33 22 31 40 59 68 7 77 8 66 9 55 0044 1933 2822 3711 454321 5 99 6 88 7 77 8066 995 45 834722354321 0 9 8 7 54321 977 886 795 604 513422331204019590868977854321 01 31240159068 86795604513 24 79 0 9 8 7 54321 73522431 63 5 4 30 2 2013902 4891 5780 654321 7 68 57 94 12 21 4 91 5 80 6 79 7068957 9846 01 03 92 47 0 9 8 7 54321 9 84 7 6 5 454321 5 81 6 70 76 85 03 12 2 14 3 03 4 92 5081 6970 7869 8758 954321 0 36 1 25 2 14 3003 499 82 59 0 9 8 7 54321 826721554321 6 5 4 3 2 5871 6760 754321 8 48 9 37 02 11 20 39 48 5 71 6 60 7 59 8048 9937 01 30449358267 61 16 0 9 8 7 54321 3 2 1 0 9 38 7050 8949838 0727 154321 2 05 3 94 8 57 66 75 84 0 27 1 16 2005 3994883 5772 6 61 75 40 39 28 0 9 8 7 54321 9178206739554321 6 5 47 3 2 854321 0 17 10 29 38 56 6 51 7 40 8 39028 01 4845736627510840993 29 96 41 0 9 8 7 54321 3 2 13 0 9 0818 1707 254321 3 85 4 74 56 65 74 92 0 18 1 07 2 96 3085 4974 5863 6752 754321 8 30 9 29 01 08 53 09 1 9010 8 29 7 38 54321 6475564653074298318920701910829 1097 2986 3875 4764 554321 6 42 7 31 82 87 76 21 0 9 8 7 54321 3 2 1 00 9 354321 4 65 54 64 73 82 91 1 98 2 87 3 76 4065954 6843 7732 854321 9 10 09 1 98 2087 397 66 33 0019 9 28 8 37 7 46 54321 655564473308229118000719954321 4855744 654321 7 22 8 11 90 28837746655 45 90 0 9 8 7 54321 7 6 5 42 3 6034 7923 8812 9701 054321 1 89 2 78 36 45 54 63 8 12 9 01 0 90 1089 2978 3867 4756 5 45 63 2109876543210987654321 MODEL NO.
SERIAL NO.
0987 54321 0987 54321 0987 54321 0987 54321 0987 54321 0987 54321 0987 54321 0987
DESCRIPTION
0 9 8 7 54321 0 9 8 7 54321 0 9 8 7 54321 0 9 8 7 54321 0 9 8 7 54321 0 9 8 9 8 70 9 7 54321 0 9 8 7 54321 0 9 8 7 054321 0 9 8 7 0 90 8 7 54321 0 9 54321 8 7 54321 7 54321 0 9 0 9 854321 9 8 7 54321 0 89 78 54321 7 54321 0 9887754321 54321 8 7 0 9 8 7 54321 00998877 0 9 807954321 0987 54321 5432100998 54321 0 9 80 79 54321 0 9 8 7 54321 54321 0 9 8 7 54321 7 54321 7 54321 0 9 8 7 54321 0 9 8 7854321 09 8 7 54321 0 9 8 70 9 8 7 54321 0 9 807954321 87 0 8 7 54321 0987 09 9 8 754321 543210 0954321 9 8 7 54321 8 7 54321 0 9 0 954321 54321 0 9 8 7 54321 0897854321 0 9 88 77 54321 7 8 7 54321 0 908978 7 54321 0 9 8 7 54321 0 9 8 70 9 8 54321 0 9 8 7 54321 7 54321 0 90 89 7 54321 0 9 8 754321 543210099 54321 0 9 8 7 54321 543210 8 7 54321 0 9 88 77 54321 54321 0 9 887754321 9 8 7 0 9 8 7 54321 0 90897854321 7 9 8 70 54321 0987 0 9 0 9 8 7 54321 054321 0 9 854321 7 54321 987 09 54321 0 9 8 7054321 8 7 54321 54321 9 8 7 54321 0 9 8 7 54321 098 8 7 54321 0 9 8079 8 7 54321 0 9 8 7054321 987 09 7 54321 0 9 8 7 54321 00 99 8 7 54321 0 9 854321 0 90 8 7 54321 7 54321 54321 0 9 9 8 78 67 554321 43 2 1 90 89 78 67 5 4 3 254321 1 9 8 07 9
BROCK NO.
SHIPPED
9 8 7 6 51 42 33 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 2 1 9 8 97 06 15 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 4 93 82 71 6 79 5 88 4 97 30 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 2 1 9 8 57 66 75 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 4 3 2 1 39 48 57 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1234567890123456789012345678 9012345678901234567890123456 7890123456789012345678901234 5678901234567890123456789012 3456789012345678901234567890 1234567890123456789012345678 9012345678901234567890123456 7890123456789012345678901234 5678901234567890123456789012 3456789012345678901234567890
QUAN.
FILLED BY
TYPE GIVE ESTIMATE
VOLTAGE
BROCK WARRANTY
TELEPHONE NUMBER
NAME
NO CLAIMS OR RETURNS ALLOWED AFTER 6 DAYS OF RECEIPT OF SHIPMENT WITHOUT AUTHORIZATION
NEW TOOL WARRANTY
SPECIAL INSTRUCTIONS
FREIGHT CHARGES
CREDIT
ESTIMATE APPROVED BY
DATE