Name DAli

Name DAli ..501(0L Address City Phone Shipping Address of &Wont from sbcvs) City Email CUSTOMER ORDER FORM IMAGE Silt FRAME LIII AMOUNT at/ GIs 44vcr Laac sisOsaer4-r 4: i Aitt __, 0, 6150. on LEA•AExIcai.r..13gotamaziL4kk2tract.i.ii:i im Et wsiwager Face .K- ik-zietc- rea. ett airtgre-c>, kl tAT 1"4..c.. 4*- 2 tue-tarc.STS&ci,-,_Wnhelo -4 5co . W _ flamed oi mak: Mon 4-6 weeks la Mau wernabcat Ali Old b A seeks for deflects AM skit les. taws customer Customs Way iflehie Meetly time. biro puma customs Loam ioclai pattages tar by pay memo All deposits are non refundibk Patrice' kith belted al 1#001, Subject to maim lees if biemni beck lobe Custom wreak: AV saks are final No cefuads. Customer Signatur Art Consultant SUBTOTAL sal whet lets aro to bo paid tvi th• SHIPPING Some counters may meat chant to en customs IA% re doe to 90 day" Minimum 20'4 Mims.' Ireland IOTA,. NOTES a (2.12 (11(2. kko A A g O . O 0 4 tett iil1C. . bilis. 44,4 50 . 00 How Ad rx, heir oboe; the LIK GALLERIES' O l'hAt -R/ 0 Rekital O Magnin, Ad O In-Rooin TV O IV Show (Social Mika 0 Oditaord 0 Mabee WSW (Capone Truck) O Email 0 011im I .IKSOHO. 4)9 West likoodeses Nay Toil We. Yak 10012 ill* 941 OM tar 212.941 6404 toe49peteilA oom EFTA00558597 12/26/2012 PEI Itt IK SOHOINC 13:53:09 Merchant 10: 000000001582241 12/26/2012 Terminal ID: 02632360 Merchant ID: 6317683621 TernLoal ID: CARD il CREDIT CARD AMEX SALE )00000000(0(3003 6317683621 INVOICE 0038 CARD • Batch 1: 000710 INVOICE Approval Code: 241827 Batch 1: Entry Method: Manual Approval Code: Mode: On'ine Entry Method: Avs Code: YY Mode: Card Code: M SALE AMOUNT $4450.00 Avs Code: YY Card Code: M SALE AMOUNT AP K 13:53:09 000C00C01582241 02632360 CREDIT CARD AMEX SALE )0000000000C3003 0008 000710 241827 Mania Online $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