JVML ORDER FORM

Part No.	Description	Quantity	Unit Cost	Total

                                                                                                                                 Grand total.................................
                                                                                                                   Deposit (min 50%)..................................
                                                                                                               Cheques made payable to G.A. VASS

Customer Name...............................................................
Telephone Number..............................................
Address...........................................................................
.........................................................................................
.........................................................................................
Post Code........................................
Signature......................................... Date....................