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'r.. . "109 RIOTS AVE STE 40. <br /> 190 u tom at SIE al ,'3 EDGOE 6 IP 56T7 <br /> (• E 544!))682 56771 EUGENE. OR 9TN7 15911 652-56T7 <br /> 1. 15911 682-5677 <br /> REPRIN REPRINT REPRINT <br /> Bark 1303 Bask ID: 1303 <br /> ID: <br /> Berk D: ID: 1251 Bao ID: 131F1 (Merchant ID: 1251 <br /> Telt Merchant 10: 1251 <br /> T.t. (D: 001 Ter. ID: 801 <br /> Phone Order Phone Order Phone Order <br /> fa/CCOl1X'CCX84S2 p 4 'OO1000123 <br /> INSTERCfB' (Mn Method: Manual is Entre Method: Manual VISA Entry Method: Maul <br /> Total: $ 100.00 Total: $ 100.00 Total: $ 100.00 <br /> 10/1549 15:42:43 10/15/19 15:41:45 10/1549 15:39:46 <br /> Lye 1: Of6811 (yr Code: 8E81E8 Inv 1: 1',1 8 Ur Code: W5918 Inv N: atm Aovr Code: 89766C <br /> AecMearvd: Online Batch': 2888tu1 ibarvd: Online Batch,: 2811 CV102 C: Online Batchp: 2E88B1 <br /> CVV2 Code: I TCH M C1V2 Cade: jt4JCH M RCVV2 Code:R. I.fMICH II <br /> (4)406 <br /> Retrieval Rei.*: 40190105 Retrieval RefAl 191114klW9 i <br /> I tree to nH above total swot 1 worn to ode *bete total amount I 'torte to oat above total tient <br /> x <br /> cordless/ to cord tasor,wrce.ent according to card noon aorenent <br /> IMerchaet ointment if credit voucher( according to cord issuer agreement Merchant arenent if credit voucher) <br /> (Merchant areement if credit voucher) ^� <br /> LCCi _ x CV x <br /> Men had C.. <br /> rim aunt Cony Merchant Cony <br /> • <br /> ..telt POS <br /> WO H 10111 AVE SIE 4W <br /> tU1lE. OR y1,101 <br /> COY F WOE FOS 1E41) 682 5677 <br /> IFO R 10TH AVE STE 4u0 p <br /> E1 CIT <br /> w72 5677 Ea 97901 <br /> (541 Y if Faint POS <br /> Tia <br /> len) 100 R 10711 AVE SIE 400 REPRINT <br /> 0.16E E. OR 97491 <br /> 15411 b82 5677 Beek (It: 1383 <br /> REPRINT lachaat ID: tri <br /> Ten ID: 091 <br /> Bask ID: In:and ID: REPRINT Phone Order <br /> Balt 1251 <br /> Ter. ID: 901 Bark ID: 1:83 <br /> no Dl 0010 1251 DCCO In�,1�,Y <br /> Phone OrderIAT,1nM0At48491 <br /> Phone Order M151ERCE Entry Method: Manual <br /> MAS1 UF1) Entre Method: Manual IXJIIC:'MXVI.AX5258 Total: $ 100.00 <br /> Total: $ 100.00 H4SIERCW Entre Meth)* Nana] 10/15/19 15:37:49 <br /> Total: $ 100.00 InvN: 880807 Nvvr Code: 819 x <br /> 1045/19 15:38:15 Anrud: Online BatchN: : '11 <br /> Inv II: .,•!:; (err Cede: 1626% 10/1549 15:36:58 CVV2 Code: MIN 11 <br /> Nae vd: Online BatS: 28EW Inv N: ;;:s', 1610r Code: 715142 Relr.nal Refit: MOMS <br /> EVY2Code: .1ICH M Ayo M: Online Batch0: :•:,A1Reten <br /> Retrieval Rd..: 2tl1Mk03 0112 Code' MPICH M I ate., to oat above tote) *.aunt <br /> according to card lister arrenent <br /> Retrieval Ref.V: 3810(.4009 Merchant artnent if credit vouciwl <br /> I agree to Pal i <br /> total amount <br /> according to card fIssuer rnwhC&-....fl4rthant ointment if credit voucheri 1 agree to oat above total apo! Y <br /> according to card issuer atottent A . <br /> (Merchant aun..nt if credit voucher) <br /> e --_ `/// -- Mn dint Cour <br /> lhre/.int Cone 1 <br /> Iknlyut Eon <br />