EFTA01110210.pdf

LSJ, LLC 6100 Red Hook Quarters Suite 6-3 St. Thomas, VI 00802-1348 Tel: Fax: 340-775-8108 E-mail: Wire Transfer Request Form Date of Request: 12/08/11 Amount Requested: $2,584.00 Payee: Suc. J. Serralles Second, Inc PO Box 801201 Payee Coto Laurel Address: PR 00780-1201 Bank Name: 'flank of America 100 West 33rd St Bank New York Address: Bank Account: NY 10001 Requested By: Purpose / Description: Quickbooks Memo: Purchase Jasmine/Citrus Fertilizer Special Notes / Instructions: G / L Account Information: G / L Description: Landscaping G / L Number: 6015Sf Authorization EFTA01110210  SUC. J. SERRALLES SECOND, INC. POBOX 801201 Number: 12.012-2011 COTO LAUREL. PR 00780.1201 Page: 1 USA Dale: 12/6/2011 Tel (787) 260-2221 / Fax (787) 260-2227 Sold LSJ Lit Ship To: To: 6100 RED HOOK QUARTERS 8-3 61C3 RED HOOK QUARTERS B-3 ST THOMAS 00802 ST THOMAS 03582 USVI Roloronco - No. Customer No. Salesperson Ship Via Terms Codo ST THOMAS 11.11.157 UPON Item No. Description/Comments Quantity UOM Unit Price Amount 01.11-24 JASMINE SAMBAS -1 GAL 253 00000 CU 5 000000 1.25000 PRODUCT OF PUERTO RICO 01.11.25 CITRUS FERTILIZER 100N 20 00000 EACH 66 700000 1 334 03 Due Date Amount Duo Disc. Date Disc. Amount 12/152011 2 584 00 0C] Remit To: Subtotal before taxes 2.584 00 SUC J SERRALLES SECOND. INC Total taxes 000 P 0 BOX 801201 Total amount 2.584 00 COTO LAUREL. PR 00780.1201 Payment resolved 0.00 USA Dlacount taken 0 00 Amount duo 2 584 00 Invoice EFTA01110211