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96207
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96207
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Last modified
7/27/2016 10:12:42 AM
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7/27/2016 10:12:42 AM
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• <br /> clry (.0 <br /> Ot LOW& Nur CITY i* EutiELE Nils <br /> 1820 ROOSEVELT BLVD 1020 ROOSEVELT BLVD <br /> BRIBE. OR. 97402-4159 iIICiE1 . OR. 57402-4159 <br /> 54411--6022-4812 541682 4812 <br /> p <br /> �R1 T REPRINT <br /> P �e merMENNIUMMENSai <br /> xxxxxxxxxxxx8697 xxxxxxxxxx7o&963 <br /> VISA Entry Method: Manual VISA Entry Method: Swiped <br /> Total: $ 90.00 Total: $ 40.00 <br /> 07826/16 15:4 .1 01%26/16 16:12:47 <br /> Inv L: 00006004 4PPr Code: 011534 Inv II: 000000005 APPr Code: 07431C <br /> APPrvd: Online APPrvd: Online <br /> AVS Code: <br /> CVV2 Cad.: MAIN Macco ogar above <br /> total <br /> dingtocard issu eragreemel t <br /> (Merchant agreement if credit voucher) <br /> I a9ree to Pau above total amount <br /> according to card issuer agreement <br /> (Merchant agreement if credit voucher/ y �+�nY1�tw/ J� I <br /> KMAI!<.;.NAIRICIA <br /> � ! !` ?./'/� /_• • t/ . Mrrcl and COPY <br /> ____✓� <br /> � (J TNAIrI( YOU! <br /> Ikrchnnl Coat <br /> 1. THAN( YOU! rirVJJJ - <br />
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