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1 / <br />~~ ~ I ~~~ l <br />~D <br />CVALCO <br />754 Olive St <br />PO Box 10286 <br />Eugene OR 97440 <br />(541) 484-5307 <br />Fax (541) 343-6335 <br />^ <br />nvoice <br />Account No. 1573 <br />Invoice No. 5015 <br />Eric Jones <br />Eugene Public Works <br />858 Pearl St <br />Eugene OR 97401 <br />Date Terms _ <br />01 %01 /2009 `~ Upon Receipt <br />Quantity Description Amount <br />1 Basic Membership - Non-profit Dues $150.00 <br />1 Additional Location $50.00 <br /> <br /> Invoice total $200.00 <br />Marketing Package(s): Kefocation <br />Category(ies): City & County Governments <br />Please remit payment to reinstate your member privileges. <br />Current 31 to 60 61 to 90 Over 90 <br />$200.00 $0.00 $0.00 $0.00 <br />Please Return This Portion With Your Payment <br />Eric Jones <br />Eugene Public Works <br />Account No. 1573 <br />Invoice No. 5015 <br />~ / i ~/~~ <br />Q I~---~ p~-. <br />v' <br />Payments Details <br />~ Payment Enclosed $ <br />~ Credit Card Account $ <br />Cardholder Name <br />Cardholder Number <br />CWR (American Express) <br />, Card Expiration Date <br />~ Signature <br />~I CVALCO accepts Visa I MasterCard / American Express I <br />~I~~, oi~-~~-~,IS~OI <br />~ ~3~p~ ,~~~'Remit to: CVALCO, PO Box 10286, Eugene OR 97440 <br />.~~ ' ~ ~j/ - T~ <br />