DELIVERY ORDER

No. 65/DN/MMS/2011 Delivery to:

CV Mitra Mandiri Sentosa
Graha Kebonsari Elveka 7 No. 36 Surabaya 60233 Telp./Fax.: (031) 8270200 Ref : PO No. 11/B02305 IO : ITEM 1 DESCRIPTION Headset Plantronic + Amplifier PART NUMBER HW251 + M22 QTY 1 pc REMARKS

GRAND SURYA HOTEL
JL. Dhoho NO.95 KEDIRI

Received in apparent good order and condition For:

Surabaya, 3 September 2011

ABDUL KHODAR

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