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<br /> CASH.,. ..... ❑ Q� ❑ CHARCsE,@KIS�ING ACCOUNT . ��j , :
<br /> SALE AMt�UNT.. ........... ..... . .. .Blll. NE�T Blll L�I � CHARGE.NEW AGCOUNT,..AUTl1C)RIaB�Sie�/.i�L�
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<br /> DOWN PAYMEN7...REQ AMT. PD. l��"}�CUSTOMER DESIFtED MONTHIY PA• ENT7�I►,tK�IINT 1!.��— ,
<br /> ' QUANTITY STCICK ^~ —�r qGGT, STONE COST AMOUNT�F SALE f/ '
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<br /> . � SUMMARY OF STORES ACCOUNTS SUO TOTAL ,
<br /> OEN•LED STORES
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<br /> STATE TAX •
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<br /> SOTAL � ^�° ` .;
<br /> SUMMARY OF REV�NUE ACCOUNTS � .
<br /> • dEN•lED ITEM ITEM TIAXfS A55ES5ED 8XQH1Pi CODB
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<br /> CUSTOMER SIGNATURE - ORIGINAI CCPv
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