<head>
</head>
<body>

<div style="float:left; width:650px;"><br>

  <table id="table_details_display" style="page-break-inside:avoid;" >
  <tr>
  <td width="296"><p>Security check:</p>
    <p>Signature/stamp:</p>
  </td>
  <td width="342"><p>Tlhomeso check:</p>
    <p>Signature/stamp:</p>
  </td><br>
</tr>
<?php if ($line_no==33) { ?>
<?php } ?>
</table><br>
<table id="table_details_display" style="page-break-inside:avoid; page-break-after:always;">
  <tr>
    <td width="296" rowspan="2" valign="top"><p>Received in good order and condition:</p>
      <p>Name:</p>
      <p>Sign:</p>
      <p>Date:</p></td>
    <td width="342" height="75" valign="top"><label class="label_plain">Remarks:</label>
      <p>&nbsp;</p></td>
  </tr>
  <tr>
    <td valign="bottom"><b>Important: </b>No claim of any nature will be considered unless rendered within 24 hours of receipt. All sales subject to our general conditions, available on request.</td>
  </tr>
  </table>
</div>
</body>