EFTA00558597.pdf

CUSTOMER ORDER FORM Name DAli ..501(0L Email Address City Phone Shipping Address of &Wont from sbcvs) City Silt FRAME LIII AMOUNT IMAGE __, at/ GIs 44vcr Laac sisOsaer4-r Aitt 0, 6150. on LEA•AExIcai.r..13gotamaziL4kk2tract.i.ii:i imEt wsiwager Face .K- 4: i ik-zietc - rea. kl tAT 1"4..c.. 4*- 2 ett airtgre-c>, _ tue-tarc.STS&ci,-,_Wnhelo -45co . W SUBTOTAL kko A Ag O . O 0 flamed oimak: Mon 4-6 weeks la Mau 4 tett wernabcat Ali Old b A seeks for deflects AM skit les. taws sal whet lets aro to bo paid tvi th• SHIPPING iil1C. . customer Customs Way iflehie Meetly time. Some counters may meat chant to biro puma customs Loam ioclai pattages en customs IA% bilis. tar by pay memo All deposits are non refundibk Patrice' re doe to 90 day" Minimum 20'4 Mims.' kith belted al 1#001, Subject to maim lees if biemni beck lobe Ireland IOTA,. 44,450. 00 Custom wreak: AV saks are final No cefuads. NOTES Customer Signatur a (2.12 (11(2. Art Consultant How Ad rx,heir oboe; the LIK GALLERIES' O l'hAt -R/ 0 Rekital 0 Oditaord 0 Mabee WSW (Capone Truck) O Magnin, Ad O In-Rooin TV O IV Show (Social Mika O Email 0 011im 4)9 West likoodeses Nay Toil We. Yak 10012 I .IKSOHO. ill* 941 OM tar 212.941 6404 toe49peteilA oom EFTA00558597  PEI Itt IK SOHOINC AP K 12/26/2012 13:53:09 Merchant 10: 000000001582241 12/26/2012 13:53:09 Terminal ID: 02632360 Merchant ID: 000C00C01582241 6317683621 TernLoal ID: 02632360 CREDIT CARD 6317683621 AMEX SALE CREDIT CARD CARD il )00000000(0(3003 AMEX SALE INVOICE 0038 CARD • )0000000000C3003 Batch 1: 000710 INVOICE 0008 Approval Code: 241827 Batch 1: 000710 Entry Method: Manual Approval Code: 241827 Mode: On'ine Entry Method: Mania Avs Code: YY Mode: Online Card Code: M Avs Code: YY Card Code: M SALEAMOUNT $4450.00 SALEAMOUNT $4450.00 1 agree to pay above total amount according to card issuer agreement. ALL SALES FINAL- NO REFUNDS CUSIOXER CON ALL SALES FINAL- NO REFUNDS MERCHANT COPY EFTA00558598