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<br />ACCT. NO. ,~ II <br /> <br />, """""'">~"~'i:'<;~~ <br /> <br />~~~~ ~~<~.;,.;;;.;'~.~~.~~~~~' . <br />S:1S9t717_107179 <br /> <br />CITY <br /> <br /> <br />0/ (f q,nd. <br /> <br />C /.2-. WORK TICKET NO. <br />1. <br /> <br />r- SOLD TO <br />ADDRESS <br /> <br />ZIP CODE <br /> <br />CASH.. .. .. .. 0 <br />SALE AMOUNT. . . . . . . . . . . . . . . . . . . . . . BILL NEXT BILL 0 <br />~r~ <br />DOWNPAYMENT...REQ I")') .- AMT.PD. <br /> <br />OR <br /> <br />o CHARGE, EXISTING ACCOUNT <br />o CHARGE, NEW ACCOUNT...AUTHORIZE~<<:z..,e- y <br />1'.f~ <br /> <br />CUSTOMER DESIRED MONTHL Y PAYMENT AMOUNT <br /> <br />QUANTITY STOCK . ACCT. STORE COST' AMOUNT OF SALE <br /> NO. ('\. ITEMS NO. ACCL UNIf <br />ISSUED AET"O NEf A NO. UNIT TOTAL PRICE TOTAL <br /> K l./.- - r-'- (/. -#- .& <br /> /""7 ... <br /> / 8?s\ rro. ~~ o?o L.L.. .... r~ /., j /? ,~ ~O <br /> ~~ ~.~ -.... <br /> I.A'./ ./ <br /> 7/ " <br /> V' <br /> I$a'{ $, .' 1 # /7:' / T <br /> - ~. ; jL;J/.At~ . '1t.-;.~t.....", < <br /> V" ;/ ...:.-,~ r, ~ t (----;? . ~. t <br /> . t-:-- /~~_ .~...(" <br /> I { <br /> SUMMARY OF STORES ACCOUNTS SUB TOTAL /2.~~: c <br /> GEN.lEO STORES <br /> NO. ACCT. NO. ITEM AMOUNT <br /> STATE TAX 7; I~c# <br /> I <br /> EXCISE TAX <br /> CITY TAX <br /> TOTAL ~325 (, <br /> <br />SUMMARY OF REVENUE ACCOUNTS <br /> <br />o <br /> <br />GEN,lEO ITEM ITEM TAXES ASSESSED EXEMPT CODE <br />NO, AMOUNT STATE EXCISE CITY OTHER S X C 0 <br />"/1'\ )<:~; C/7'/, ~-}C' -rC;.J 160 <br />7'f"- {() 2-;''/. 0(", --- <br />~<..,; ';.y;. <br />. <br />TOTALS <br /> <br />'::JSTOMER SIGNATURE t;~ ~~/ IJ ~h ;(I''''' <br />, I - SAUHOVISIONSON IlVIllSUIOEOFCltSTOMIIlCOil"f. <br /> <br />ORIGINAL COpy <br /> <br />L <br /> <br />L <br /> <br /> <br />o <br /> <br /> <br />"i <br /> <br />I <br />", .J, <br /> <br />-.J <br /> <br /> <br />" <br />,-. .' <br /> <br />,. <br />