EFTA01221332.pdf

Invoice No: 0 Cust P.O: Bnrkhard's Tractor & Eguipment,/nc. Date: 09/04/15 Cust ID: LSJE9 4180 S. University Drive Salesperson: Steve Terms: Quotation Davie, FL 33328 Page No: 1 Tele: 340-775-2525 954-475-0310 Copy No: 1 QUOTATION SOLD TO: SHIP TO: LSJE,LLO 9 E 71ST ST NEW YORY,NY 10021 Quan Part Description M£g Bin Tax Each Extended 2 792105 FILTER-AIR CL (MIU11515) BS SC8 N 24.60 49.20 2 MIU11517 FILTER (792303) JD AA4B N 8.14 16.28 1 M158130 V-BELT JD WALL N 73.76 73.76 3 M145476 BLADE (GATOR 596-354) JD MBA3 N 15.36 46.08 2 12950 INLINE FUEL FILTER EIS RO SHWRM /SB4 N 6.95 13.90 4 AM125424 OIL FILTER JD SA6/D2A N 10.54 42.16 1 AM131054 OIL FILTER JD SA4 N 17.64 17.64 4 MIU11020 Spark Plug XC92YC 7920153D B1G1E N 6.83 27.32 286.34 10% Discount 28.63- Total 257.71 "*RECEIVED EY: "PRINT NAME: - RECEIPTS REQUIRED FOR RETURNS AND WARRANTY WORK - NO RETURNS ON ELECTRICAL PARTS - NO RETURNS AFTER 7 DAYS / NO REFUNDS ON SPECIAL ORDERS - 20% RESTOCKING FEE APPLIES TO ALLOWABLE RETURNS WITHIN 7 DAYS - NO RETURNS ON CHAINSAWS/OENERATORS EFTA01221332  We Strive for Excellence in Sales and Service Steve Landis Sales Manager 4180 S. University Drive • Davie, Florida 33328 (954) 475-0310 Ext. 30 or 17 • Fax- -0 E-mail: steve( • Wcbsite: CREDIT CARD AUTHORIZATION FORM Date: IF INDICATED, THIS FOR A ONE-TIME CHARGE OF Sigo 7, -71 I HEREBY AUTHORIZE BURKIIARD'S TRACTOR & EQUIPMENT INC. TO CHARGE MY: VISA / MASTERCARD / DISCOVER / AMERICAN EXPRESS Cardmember's Name: #4,,,in( W04/;70eZ. Company Name: C5 78, liC Phone Number: Account n: 3 7 7 _Li al 1 _a -3 01_2 ■ Expiration Date t / ao CV2 Info 7 00 3 digits on the right side-back of card Month / Year Cardmember's Billing Address: ?E 7/s SimE4- Neu) $el, Shipping Address: (Ifitems are to be shipped, Please note shipping charges will apply) 2.5TE, 21C. - St. Thotmq-.5 TRopiall SAippit) 9505 WES+ / E. ,331788 Curdmember's Signature _5-SA PLEASE FAX/ EMAIL TH S-VORM, WITH A PHOTOCOPY OF BOTH THE FRONT & SACK OF THE CREDIT CARD, AND A PHOTOCOPY OF PICTURE IDENTIFICATION TO: 954-475-0465 OR sales@ **Please be advised if this form is not filled out completely and the requested documents attached, we will not be able to process your order. Thank you! ** EFTA01221333 PASSPORT PASSEPORT , PA SAPOkit TyPinIti/ P'";} supftwee./39/ RODRIQUEZ2.:. -.GartGailirakkin/.11 de rn t/arosity / UNITED STAY A R Shed • ',roma -3> /1.,...:0:\ . ,t 0 ... •.:Sta/W„. , luixotinginIase :.Giu.., "US. VIRG IN IS argeSde• MAXtilt*SOISA V./I...-. • M and nwiCiaceecitliviitilteSk efl kil :. M F: /IL M rtiiiii -was., ..;f ''.ittik a11,01Cr 710.1.ttire ‘-d:C litees : iltA ea4 . F. . , • ‘' 1:16114$11 ! .C: ..:.... "-'6 ' • :9‘S'115.nr? i3bgrt SC ::'' 7'.2A etoi scia ltraA raidt ees ra lS 7 . '.: Emid*redisil A . SEE PAG E 2r, •f• EFTA01221334