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1 <br /> (: '1)—: °"--( 2--- 71/4° <br /> CITY G Mut PGS <br /> illi a ftaT1E VOS 1 CITY Cl WOE Ks <br /> Ib0 N 10111 AVE SIE 9W I'M. “.INAVE Sit 909 IW N 10111 AVE SCE 400 <br /> fINTIY. CO 97401 /UAW. 1.199i Wl CUTIE. 11!97991 <br /> 15911 E.*Sea tui l 6V2 56x7 1541)6Yd-56rt <br /> aEPRINT a REPRINT <br /> Bet* Ib: INI. <br /> Bad ID: 1384 Ilerclwe ID 1(4; Dani ID: 1393 <br /> Merchant I0: 1261 Ter. ID: 001 Me.chant 70: 1251 <br /> Ter. ID: 001 ler. Ib: bBl <br /> Phone Order Phone Order Phone Order <br /> N' C JW2333 )2)01(11a04243 )4=13 <br /> VISA Entry Method: tbro al VISA Entry Method; Ibnoal VISA Entry?:: oa. $jrnal <br /> Total: $ 15.00 . Tot 1 90.00 Total: $ 80.00 <br /> a <br /> 61/10'19 13:19:43 B7/18/15B7/18/15 ` 15:(6:21 67i18/19 69:83:06 <br /> un u: NC 3 Axe Code: 181996 In, N: 66C+ib : . Avor Code: 161921 <br /> Aond: Online Batchu: 19181 twill : Onln4 <br /> e4hel: 6119d: Olile <br /> BatchU: 191601 <br /> CW2 Code: MICH h CVV2 Cede: Milli BCVY2 Code: P 1CH M <br /> Retrieval R0.0: 4bIWWl Retr ins' Rel.n. Mom; Mel.,v al Ref.N. 7olo0l$1 <br /> I agree to oev above tota: mount I Mee to on cardabie total aeouet I awve to Kay above total Sewn <br /> accordingrch.atto C ii v abetment <br /> according to card ISYS' voucher' Merchant nreernt if c dlt voucher) accordlnN to ted latrev_ axeeaent <br /> )Merchant sw'ee.ent if credit wucherl ��110 Merchant a-reesent if credit voucher) <br /> x_21 6,- �/)1.- _ Lip ti. L /J - a 1�_ <br /> Me..L+A Col.' Isla dour Conga' Me.eiveol CW'. I , \ <br /> DICKY/Itls INNISal:1IW rtERYVIIV IKSgSa•^IIW MAW I EDW <br /> AWA IIW <br />