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i~~, <br />=~., <br />ooz3 <br />~D~ERTTSER: •C~~''~~'~.~~~~~'-,~,EU~NE ~~~ ~S, ROT~RY~` <br />~~ <br />DESIGN; ~ <br />;~' <br />.~ ~~ ~.: T }I 4 kt <br />L~A~iAR I D ~~NO : ~ ~ 7 7 7 ,~,~~'~ ~fi-~ F~' ;~;. 4 <br />~ ~ti.~, ~ 1 <br />.... ~e.'k~r' ~I~ <br />~~~~~~ <br />ET~C7ENE , OR ETAS TRANS Z <br />Credit Ord Intorrnation; <br />Name as it appears ors your credit card: <br />Account # <br />VISA ~ <br />n, <br />w~ ~ •~~ p.0. BOX 9603Q, ~ATDi~ ROUGE, ~A 70896 <br />~ ~ ~ 2 ~ - 9'l 9 ~ x 2 8 OR 22~-9~~~1000 <br />INS ~'~: ~4~.~.8~.'T525 <br />AOGOUNT N0; ~~08~2 D0~ IN~TOICE 1~~TE: 3~20~~~1Q <br /> <br />............. . <br />MAST~~CA~~ ^ ~M~RICAN E7~~~E ~ <br />cr~Y of E~GE~E ~~R~s, <br />.A. ~ ~ if V • V V ' <br />... <br />LSE ~~TE~ ~]2c/~~~~ <br />ChecklMar~ey Order ^ <br />ROTARY X25 <br />Bilk ~o Address as it appears an your credit card dill; <br />Si4r±•ature; <br />By signing this you agree to all #erms a# our ca~traci;, <br />date: <br />expiration date; <br /> <br />CITY OF EUGENE PARK, ROTARY <br />~8~~ ROOSEVELT BLED <br />EUGENE, Old ~740~ <br />.~._. -_~.m.. ~ 6~5~~0$42~0~4 <br />~~~:~~a: <br />AID ~"N E LAMAS COMPAN I ~ <br />~~ 6AT~N ~OUG~, LA 74896 <br /> <br />if{~. <br />