DS9 Document EFTA01221762

DLM PlaStics Authorization to Charge Credit Card Date: 7/14/2015 Attention: Ann Rodriquez RE: PURCHASE ORDER Company: Rodriquez, Ann DJM Plastics Ltd dba DLM Plastics 1530 Harvard Avenue Findlay, OH 45840 Phone: 419-424-5250 Fax: 419-423-0849 ONE TIME SALE-LININGS DLM Account It: 5026.003 Thank you for your above-mentioned purchase order Since you have requested to pay for this order with your credit card, this form must be filled out and signed BEFORE we can proceed with your order. BILLING INFORMATION (the address at the e Name as it appears on credit card Billing Address: City, State and Zip Code: Contact Telephone Number c rd bills to) I Credit Card Type: SHIPPING INFORMATION (we cannot ship to a PO Box) Name: Address: City, State and Zip Code: Contact Telephone Number: 453£,LIC- 6+, 77mms;, 1RopicAl Sivp;Apet 7505 N W infei-WAttrivui Mgt12 3J 7R c= at= Credit Card Number: Expiration Date: Security Code:a_(Visa/MC three digit code on back or American Express lour digit code on !front) DJM Plastics is authorized to immediately charge the following amount to the above account number: Descnption 12 Feet WIde x 300 Feet Long Flat Sheet Pond Liner In 40-mil Black CWPE Shipping & Handling to: 33178 n/a U.S. Dollars Material: $2,182.36 Shipping 8 Handling: $560.57 Tax: $0.00 Other S0.00 Total to be Charged: 32,742.93 It is agreed that the material will be shipped, n/a Total for All Items Listed Above Within five (5) business days from receipt of payment It is further agreed that shipping & handling rates are sometimes estimated and may vary slightly from the amount quoted and discrepancies will be billed separately. NOTE: Prices shown do NOT include any cross-bord es-andfees as tai are pa le by the recipient directly to the freight carrier PRODUCTS DESCRIBED HEREIN ARE CUST E AND Tlf Signature of Cardholder: Date: (FOR INTERNAL USE ONLY) Authorization Number Processed Dy. DLM Order Number: Date EFTA01221762