Gentlemen: If you decide to produce a 1969 Hurst-Olds conversion, we would like to purchase the following number of units. Quantity Hurst-Olds with Air Conditioner ________ Hurst-Olds without Air Conditioner ________ Total Units ________ (PLEASE TYPE OR PRINT) ___________________________________ ____________ Dealership Name Dir. Code # ___________________________________ ____________ City and State Zip Code # _____________________________ Authorized Signature, Title