The HX codes and the time are optional. As much location and contact information as possible should be included. The primary means of delivery is by telephone when regular public communications systems are operating normally. 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: _________________________________________________________
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PHONE: __(____)_________________________________________________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
SIGNATURE: ___________________________
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