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• <br /> I Ili or CILLNt INS • <br /> IW k 10111 AVE Sit 9W <br /> C(Sill OR 97901 <br /> 15911 502-5677 Clly of t:AtR INS <br /> WO 11 10111 ALS $II 400 <br /> 'CL:t12.103 Watt. OR 97•iv1 <br /> U9,11'1•J S p•�7 tl:r:A AVES 1'O) 15411 >?5677 <br /> 101115 nLr I IW a IUM A51C 4W . <br /> Wink. OR 9'.901 <br /> �"' "`S6Y7 - REPRINT <br /> 011V • PRINT <br /> u., W <br /> chart h.: 1 <br /> Ne: <br /> !., L.4 Sal. local l 10: •:5L <br /> Ice. I0: 001 <br /> ita <br /> lOO.W O.i ILS 103a 1 180.W hes <br /> IU: 1251 Phone Order <br /> Sate Iet,l; f 100.141 <br /> ler. ID: 001_ <br /> Total: <br /> 1vR.w Refund ' %XX1CV11Yt'':1 <br /> . <br /> { VISA Entrr Method: Manual : <br /> VISA ntnr Method: llan al Total c $ <br /> file,. tutNt PUS Total: $ 155.00 �� 09-1✓19 15:112:23 <br /> IW u 1018 AK SIC 90U A... Code: rig <br /> tUtiME. OR cb961 fs912'19 la q: BN0B01 MM <br /> es911 6Ai.S077 16:13;08 <br /> Inv q: I'll Aar Code: 152123 Avmd; Cnlice(N Batchq: 2S5JB1 <br /> Tera In. 1Apprvd: Online Batchr: 255 1 CN2 Code: 11Q M <br /> U§.121Y 71 tlZ.i: Rek uwi N<I.II: .vsthart <br /> 1['11 p[1ylp krt:teval Re... 2111MNA2 <br /> 9Ei1tElE10 RffORi I .+nee 6 ear dv.- ..nal awe[ <br /> I avv<e tv war ya. Letal roan[ r;p-dln9 to cod tai+: agreement <br /> Halla 4w: 1 10J1 acrpdrnva to card wr are<ant Ityr<hant aw rein[ 1E rreJtt vax/herl <br /> No.1 Na, . 1411V :9Kdanl svns.en! 1:45%credit vwtherl �o I rl <br /> IM'fha,d: 1 <br /> :ales 2 4 .ic.iE"� / <br /> X. S ���� %— \i) <br /> — <br /> Talal f `''l t��5 <br /> Settleoent Successful :a.l.,J civ <br /> h„clam.•[ Colo <br /> (11Y 01 [halt PS <br /> IW G 10111 AK SIE 910) <br /> t1Yt11. OR 97901 <br /> 15911 1,X7.5677 <br /> REPRINT <br /> OwA t0: 1031 <br /> J. * Ik+'cla:.t ID:: <br /> 1251 <br /> Te,. In: POI <br /> 1 is •5 + Phone Order <br /> 17 <br /> 5•': + %OCdII%%X9b�3 <br /> VISA Entrr Mathod: Manual <br /> .01 78; '� * Total: $ 155.00 <br /> 0971249 15:03:11 <br /> Inv I: 11:,.7 far Code: 029355 <br /> Aor,•ld: (kltne Batchll: 25381 <br /> R<4'evil Net.9: 80114111.11 <br /> I agree to vav above total awant <br /> according to csd issuer covenant <br /> I1➢rchant awee.ent if Credit vovcherl <br /> % a1? I ra. 49 <br /> • <br /> { Y .yCr, w : �t ' I,t•l <br /> �d i r I et kr `t \ • Mrclrvl Cove <br /> = 4,' ttrli- N. 1S'iJU It c•.:g.. <br />