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The image shows a yellow form with black printed text and a handwritten note at the bottom. The printed text reads "ITEM WAS NOT SCANNED" at the top in large, bold letters. Below this, there is a line labeled "Description" followed by a space for writing where someone has written "Fax Cover Sheet" in handwriting. At the bottom of the form, there's an official-looking logo and text that includes "Official Delivery Instructions" and a date "August 29, 2013." The style of the image is straightforward and informational, typical of documentation used to indicate non-scanning status for items in transit or delivery.