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(-I i e)- /5/1 9 1:-.- - 3 0 3 g2-- <br /> • <br /> LI IT th W1H1. I V MY(A IIYIIF Flt) <br /> 100 N 10TH Act SIE 400 ICV Y Pith AVE 5k 4w <br /> ELIDE. OR 97401 I&IDE. In 97401 <br /> 1541)612•5677 15111 bbl 5677 <br /> [4,25/1 23:12:10 REPRINT <br /> OM Tee. It, LSI <br /> YI.�E 'Mal Phone Order <br /> lrJ Cot 5.41. <br /> IC 1 I1S In I15.0O , <br /> )11 <br /> )000'W' <br /> sat. I.t.1' $ 15W yF(TGM1VWO [ntrl ythd: Manual l <br /> ,.dal: 1 <br /> Total: $ 115.00 <br /> 019 12:13:09 <br /> )I,n.v._A: 0100001 kcCo_Co�lde��: 1522L68 <br /> OI7Y u ELIDE POS ryry�I4��: Online MIN <br /> y OOtI,NI: 11%81 <br /> 106 t . AVE SIE 4W 6112 COie: MICN h <br /> /del/• w 97401 <br /> 15971 58`A,77 N.h t.v.1 Ref.U: w1Ww1 <br /> 1w_ ILL WI <br /> I tree to oar above total amount <br /> 1lI,2S•19 21'1)/'IS accardln9 to card Inter aareea.nt <br /> Merchant arreeeenl If credit voucher/ <br /> 111011 <br /> SFfiHuh. 11Z501 14.2/4 , 91a <br /> float.,t Ila: L1 1 A <br /> her hint: l <br /> Slee 1 9 /IS VO <br /> Ile..Eau' Coo, <br /> Total . 1 S 11 .w <br /> Seftlerent Successful <br /> EUNYPILI. IR:JI;aCIICI <br /> umeamiMMEM <br />