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