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| His Majesty's Ship [_________] at [_______] day of ________ 18 __ |
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| Received from Mr. [_______________] |
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| Carpenter or Boatswain, &c. of His Majesty's [___________] |
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| the following articles for the use of the [____________________] viz. |
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| Here insert the articles and the quantity of each [in words not in fugures]. |
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| Form for the Bill of Exchange |
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| Pay to the Commissioners of the Navy, or their order, such sum as they may judge a proper valuation for the Stores specified in the Annexed account, supplied for the use of the Ship. |
| [_______________] under my command on the [___________] |
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| To Mr. [______________} |
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| Owner of the Ship |
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| at [______________] |
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