Preamble:
Number: 
     This is a service message
Precedence: EMERGENCYPRIORITY (P)WELFARE (W)ROUTINE (R)
     This is an exercise
HX:  HXA        (click for more info on handling instructions)
     HXB 
     HXC
     HXD
     HXE
     HXF 
     HXG
Station of origin: 
Check: 
Place of Origin: 
Time Filed: 
Date: 

Address:
Name:     Call Sign: 
      
Address: 
         
City/Town: 
State: 
Zip: 
Phone:     Ext: 
Email: 
Op Note: 

Message:


Signature:
Signature/Name: 
Op Note: 

HANDLING INSTRUCTIONS, [HX ], OPTIONAL

OPTIONAL. Do not use handling instructions unless a particular need is present. Handling instructions are used to instruct the relaying and/or delivering operator to handle the message according to the following codes (Refer to ARRL CD 218, pink card.). If used, handling instructions must stay with the message to the point of delivery.

* HANDLING INSTRUCTIONS (ARRL, FSD-218 2/91)
HXA__ (Followed by number.) Collect landline delivery authorized by addressee within [....] miles, (If no number, authorization is unlimited.).
HXB__ (Followed by number.) Cancel message if not delivered within [....] hours of filing time; service originating station.
HXC Report date and time of delivery of the message back to the originating station.
HXD Report to originating station the identity of station from which received, plus date and time. Report identity of station to which relayed, plus date and time, or if delivered, report date and time and method of delivery (by service message).
HXE Delivering station get reply from addressee, originate message back.
HXF__ (Followed by a number.) Hold delivery until [date].
HXG Delivery by mail or landline toll call not required. If toll call or other expense involved, cancel message and send service message back to originating station.

* MORE THAN ONE HX CODE MAY BE USED. If more than one code is used, they may be combined provided no numbers are to be inserted, otherwise the HX should be repeated, thus:
NR 27 R HXAC W1AW..., or, NR 27 R HXA50 HXC W1AW...(etc.).