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* q ' - 31' (0 a( 1//1(:) <br /> ________________ <br /> ._.________—_________.. <br /> 1 <br /> i <br /> CITY:1F Mat PUS <br /> 1828 ROOSEVELT BLVD <br /> EOM*, OR. S7402-4159 <br /> 541-682-4812 <br /> 31.16 22:32:08 <br /> TOTALS REPORT <br /> El3a <br /> L..: fait l Pr oau TILs1 <br /> Vt -._.. 2 VP' „0 U 00 190.00 <br /> Sate total: i 1%001 • <br /> Total: $ 198.08 CI IY 111 Blatt. 0:1:i <br /> 1820 R')' iVtlr 8f VG l:l1Y Id EVLI rt I'0'., <br /> LORNE. OR ST4U2-415S <br /> 1120 Mlib;EVLLT dt'1f <br /> 541 682 4812 URINE. OR. 51402.1::4 <br /> � `:41�bil'l.•4dIL' <br /> REPR 'a <br /> /' ` Llly :x et;;fr1E PUS IMMILLGAllanani <br /> Phone •' _- <br /> 182d ROOSEVILT BLV(( - Phone 0 �- ..2.':' <br /> LUGEHE. OP 97402-4159 a�axxxxxxxxx4L41 pp7 <br /> 541.6n2-4812 nxxxxxxxxrx1J01 <br /> 08 31;16 22:32 [5 VISA Entre, Method: Mantel VISA Entry "�thud: lE;1x;3! <br /> SETTLEMENT REPORT Total: $ 75.00 Total: $ <br /> iii. ; <br /> y�t.l.ling: lye 08/31/16 16:12:40 064146 13:5O;66 <br /> Ilrlae:c Ela•.on Inv q: ,;r; 4,�' APPr Code: 061240 <br /> 1;s, l,anc: 1Inv I!: 000600001 Am.Code: 0E89$ <br /> wassaimilmommaintimmia <br /> ale> : 2 , 1.30 du P.uarvd: Online APPrvd: Online <br /> Total . 2 S 190. 0 AVS Cade: EXAC MAiCN Y <br /> CVV2 Code: MATCH M A'�S Cad;: ZIP MATCH <br /> l <br /> S ttlenent Successful 19ATCH M <br /> CVV2 Cit: , , . <br /> i <br /> GnGK 1:1:109010132 <br /> 1 agree to nag above total mount <br /> according to teed issuer agreement <br /> I aeree to Mar ab ve Lvtel ar+ouet <br /> (Merchant agreement if credit ,.oucberi <br /> (Merchantaccording a fo card ismer, agreeanc <br /> 'evreement if credit van:heri <br /> j„,j1„ fo-e <br /> L- <br /> t#a, nl e„ r <br /> n<, f ”t co, <br /> 7iiNh Y11! <br /> # 27A11f 71IWlk Y011! <br /> . <br /> '.01 <br /> 75.00 <br /> 0. <br /> Q( 115.00 + <br /> 001•.•••.. ... • <br /> 115.00 * <br /> I <br /> 0• * <br /> 75.00 + <br /> i 11 ^i + <br /> 002400,00• 200•- <br /> c(0 90.00 <br />