| Heading and notes: | No form number. | 
| Message area: | Unknown. | 
| Reverse side: | Blank. | 
| Colours (text & form): | Black on light cream. | 
| Size of form overall: | ?? mm. | 
| Size of datestamp box: | 28 × 46 mm. | 
|  Printed in May 1903. | SI-DO-1. Gladstone to Parkside Characteristic: 
 Delivery form trimmed by previous "collector". | 
Details of use and rarity.
| Form sub-number | Schedule number | Earliest recorded date | Rarity rating | 
| DO-1. | 265,000 - 25-5-03. | 30 July 1904 at Parkside. | RR |