Vintage form, COCA COLA BOTTLING COMPANY Holdrege Nebraska Statement of Employee's Earnings in n-mint+ unused new old stock condition. Nice clean form. Size is 5 1/4" x 7 5/8". Scans show front, back is blank. The black border is so all the edges can be seen and is not part of the form itself. NOTE: All of the advertising items I have listed are guaranteed to be 100% authentic originals. They are all clean and ready for display. Thank you for your purchase I appreciate it.