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li)5 . 9..."--. <br /> ICCI9 ROOSEVELT BLVD BLVD 1�a EUGENE POS Cllr of EU[ftt POS <br /> EUGt)E. OR. 97402-4159 maw. oR, 99774 .4jj59 IS2D S�DSFVFLi BLVD <br /> 541.682- 5541.582.4812 EUGENE. CA.2977B4159 <br /> REPRINT REPRI T REPRINT <br /> Phone Order r Phone Order i Phone Order <br /> bna000arloa Ge. unzocommc4811 <br /> VISA ERN Method: taxa: ;:9 Entre Metlwd: Man11a1 VISA Entre Method: itaria! <br /> Total: $ 100.00 Total: $ 100.00 Total: $ 100.00 <br /> 18/17/18 14:38:61 18/17/18 14:4817 18/17/18 <br /> Inv t " c ,:;c Noor Code, ^::a Inv 1: t;ssras Noor Cock: ent, Inv I: s;srs;s, 14:41:18 <br /> Noorvd: Online Pored: dine korvd: OCR. Code: B64�D <br /> NS Cc&: AUS Cade: NVS Cie: <br /> CVV2 Code; MEN M C41e2 Code: WO M CNf2 Cade: MAD M <br /> 1 arta to oar thew total awnt <br /> I aura to NO aoow total <br /> according to card Issuer aarree�ent accordlna to card moue.-as-gement <br /> amount <br /> I agree. to above total amount aretmnt if credit washer) (lttrchent areewnt ti cred(.t voucher/ <br /> (Marchant afretomant if creditwatchrentntr! <br /> h..n.,t COM, Merchant Cat.. <br /> 1}s Milt i1KN( YC)! <br />