PRINTABLE PURCHASE ORDER FORM
     TO:    
 SALT OF THE EARTH WEIGHTED GEAR - 414 RD D 1050 - HENDERSON, NE, 68371

  COMPANY:______________________________                        PURCHASE ORDER NUMBER______________

                                                                                                                                                     DATE__________

     
 BILL TO:                                                                               SHIP TO:












NOTES:
                                                                                                                                                  
Contact Person:                                                                        PAYMENT:
Name_______________________________                        
 I HERBY CERTIFY THAT THERE IS AN UN OBLIGATED BALANCE IN THIS
                                                                                                                                                                                    APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER

Number______________________________



                                                                                                                                                                                    ________________________________________________________________________
                                                                                                                                                                                                   SIGNATURE