The HX codes and the time are optional. The telephone number is optional, but should be included as it make the message much easier to deliver. The form has five words per line to aid in counting the check quickly.
Remember the check is the number of words between the "BREAKS".
NR__ PREC__ HX__ STATION_____ CK__ PLACE_______ TIME____ DATE______
ADDRESS: _________________________________________________________
_________________________________________________________
_________________________________________________________
PHONE: __(____)_________________________________________________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
SIGNATURE: ___________________________
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