jay dee equipment ltd. service invoice - kramer · pdf filemsc kover 3 . 25 230.78. 03 ......
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JAY DEE EQUIPMENT LTD. Service Invoicewww.jaydee.ca
SWIFT CURRENT, SK2674 South Service Rd. W., S9H 5J9
Ph: (306) 773-9351 Fax: (306) 773-2045
JAY DEE MAPLE CREEK, SK KINDERSLEY, SK KYLE.SK LEADER, SKE Q U I P M E N T LTD, Ph: (306) 662-2233 Ph: (306) 463-2683 Ph: (306) 375-2302 Ph: (306) 628-3889 JOHN DEERE
SOLD TO:
INVOICE DATE
0 8 D E C 0 6
BRANCH
03
INVOICE NO.
5 4 3 2 3
M U R R A Y C ow IEB O X 8 4
F L A X C O M B E ,
PURCHASE ORDER NO.
MAKE
JD
MODEL
8 4 5 0
S K S O L 1 E O
PHONE NUMBER
3 0 6 - 4 6 3 - 3 0 3 9SERIAL NO.
PAGE
1SALE TYPE
O T H E RCUSTOMER NO.
4 6 3 3 0 3 9 0WORK ORDER NO.
R W 8 4 5 0 H 0 0 3 9 2 3
5 4 3 2 3EQUIP. NO.
SEG
01
4 W D T R A C T O
METER
4
SH
P
T0
DATE OPENED
2 6 0 C T 0 6
103
A
. 0DESCRIPTION
4 5 2 0 B 8 3 8 0 0 0 9 6 1 5 3 8 1 - 0 7
SALES PRN
38UTHORIZED BY
AMOUNT
" F r e e T r u c k i n g "
* * T O T A L L A B O R * *7 1 M I L E A G E D E L L O A D / K
1 - S E R V NON - LBR D I S C
».->
G O
S E G # 0 ] P R T 0 0 L A B
W I T H THE G R E E N S E R V I C E IN S P E C T I 0
9 9 P O ] N T G O W I T H T H E G R E E N S E R* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *H O U R S 4 1 0 3T R A C T O R D Y N - O E D - A T :
- -.-
B E F O R E* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *D O E S T H I S U N I T G E T A N S P I S T I CT H I S U N I T H A S H A D A F I N A L C H E C* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
N
V*
H*K
M
A L
. 03
C H E C
M S C
K O V E R
3 . 252 3 0 . 7 8
. 03 - TO
5 4 9
I C E S P E C I A L C H E C K L I S T
. 03230 . 752 3 0 . 7 8 -
TAL . 0 0
* * * * * * * * * * * * * * * * * * * * * * * * ! * * * * *
P ; A F T E R 200 H P* * * * * * * * * * * * * * * * * * * * * * * * * * * * *ER X _ Y E S
K O V E R*
C H E C K E D T R A C T O R A N D M A D E L I S T .C H E C K E D A X L E S - LR - .F R T
0 0 6 , R-R- . 00 7
DHNO( I N I T I A L )
* * * * * * * * * * * * * * * * * * * * * * * *
C H E C K E D, LF-
W I T H C U S T O M E R .. 007 , RF - . 008
A X L E P I V O T B U S H I N G - . 0 0 8W A S H E D A N D W A X E D T R A C T O R . C L E A
* * T O T A L1 - S E R V L B R
»- -> S E G # 0 2 P R T 0 0
L A B O R * *N ED C A B .
D I S C - A L L
LAB ] , 4 9 6 . 2 5
947 . 25
* * * * *
1 , 496 . 25947 . 25 -
M S C 9 4 7 . 2 5 - T O T A L 5 4 9 . 0 0* G S T / H S T * 32 . 94
E N G I N E
Terms: Payment due on receiptaccompanied by this invoice, be in a
of invoice by cash, cheque, Visa, MasterCard, AgLine, or AgriCard. Any returns must bereturnable condition, and may be subject to a re-stocking fee. Special order parts are non-returnable.
D 1 herby certify that I am engaged in the business of farming and that the goods shown on this invoice will be used exclusively for that purpose.
Sec. Twsp. Rge. _ W3
Any unpaid amount will be subject to a service charge of 1 Vz % pt
i hereby authorize the above repair work to be done along withmay operateon above mac
above machine•hine to secure
forthe a
purposes of testing, inspectionmount of repairs thereto. It is un
r month for an APR o 18% effective the date of this invoice.
the use of necessary materials. You and your employeesor deliderstoo
L/ery. I agree td that this com
o a Npany
1ecass
hanic's Lierumes no re
is acsponsi
cnowledgedailrty for loss
or damage by theft or fire to machine placed with them for storage, sale, repair or while field testing.
RECEIVED BY DflTE
DESCRIPTION AMOUNT
TOTAL PARTS
TOTAL LABOR
MISC. CHARGESSALES TAX
PLEASE PAY KTHIS TOTAL W * * C O N T I N U E D * *
LF-1152C Ver. A CUSTOMER COPY GST 10259 2813 RT
JAY DEE EQUIPMENT LTD.
www.jaydee.ca
Service InvoiceSWIFT CURRENT, SK
2674 South Service Rd. W., S9H 5J9Ph: (306) 773-9351 Fax: (306) 773-2045
JAY DEE MAPLE CREEK, SK KINDERSLEY.SK KYLE.SK LEADER, SKEQUIPMENT LTD. Ph: (306) 662-2233 Ph: (306) 463-2683 Ph: (306) 375-2302 Ph: (306) 628-3889
SOLD TO:
JOHN DEERE
INVOICE DATE
0 8 D E C 0 6
BRANCH
03
INVOICE NO.
5 4 3 2 3
M U R R A Y C O W I E PAGE s
B O X 8 4 2 , 4 5 2 0 B 8 3 8 0 0 0 9 6 1 5 3 8 1 - 0 7SALE TYPE p
F L A X C O M B E , SK SOL 1EO O T H E RCUSTOMER NO. Q
PURCHASE ORDER NO. F
MAKE
JD
MODEL
8 4 5 0
3HONE NUMBER WORK ORDER NO.
3 0 6 - 4 6 3 - 3 0 3 9 5 4 3 2 3SERIAL NO. EQUIP. NO.
4 6 3 3 0 3 9 0SEG DATE OPENED SALES PRN
03 2 6 0 C T 0 6 38METER AUTHORIZED BY
R W 8 4 5 0 H 0 0 3 9 2 3 4 W D T R A C T O 4 1 0 3 . 0DESCRIPTION
C H A N G E D A U R F I L T E R S . R E M O V E D HF R O MW I T H
I N T A K E A N D 3 F R O M E X H A U S TN E W G A S K E T S . R E P L A C E A L T E
P U L L E Y . R E P L A C E A L L B E L T S . R E PC U S H J" O N .
1 N R E 5 2 4 4 0 9 G A S K1 N A R 7 0 1 0 7 F ILT1 N A R 7 0 1 0 6 F ILT1 N A R 5 7 2 6 6 : B E L T1 N R 7 3 1 8 9 ; ; ;---B--El-T1 N R 7 1 6 0 3 ' / B E LT1 N R 6 9 1 6 2 ; : P U L L1 N A R 9 2 5 9 3 S E A L1 N J D 8 6 7 0 B A L L1 N R 6 6 0 7 7 ' CAP3 N 1 9 H 1 7 6 5 3 / 83 N 19H2128 3/81 N 1 9 H 2 6 3 9 3/81 N 1 9 H 2 5 4 9 ; 3 / 87 N R 6 3 8 4 5 W A S H
10 N 1 9 H 2 8 5 2 5 / 1 62 N 1 9 H 2 7 2 9 CAP6 N 1 9 H 3 2 1 9 CAP1 N R 7 8 2 0 2 C U S H1 N R74114 IDLE2 N R 5 1 9 3 7 T U B E6 N R 5 1 9 3 6 S L E E2 N 6 8 X 21 N A R 7 9 7 1 1 OIL6 N T Y 2 2 4 1 7 B U L K
Terms: Payment due on receipt of invoice by cash, cheque. Visa, MasterCard, AgLine, oraccompanied by this invoice, be in a returnable condition, and may be subject to a re-stocking fee. Sp
E A D A N D R E M O V E D 2 B R O. C L E A N U P A N D A S S E M BR N A T O R P U L L E Y A N D T E NL A C E H Y D R A U L I C C O U P L E
ET KIT 189E R , S E C 3 4E R P R I M 8 2, F A N 18
CB / g
8E Y C Y 6 9
11B E A R I C Y 4 1
4X 1 3 / 4X 3 1X 3 3/8 1X 1 7/8ER 1
X 4 CY 1S C R E W C Y 1S C R E WION 16R C Y 95
NUT 1V E R U B B 1C O M P MA 1L I N E C Y 2 2
H O S E
AMOUNT
K E NLE hS I O NR
. 75
. 49
. 80
. 98
. 91
. 34
. 00
. 49
. 69
. 20
. 86
. 04
. 21
. 86
. 27
. 38
. 38
. 58
. 96
. 45
. 90
. 44
. 65
. 14
. 26
AgriCard. Any returns must be DESCRIPTION6cial order parts are non-returnable.
n 1 herby certify that 1 am engaged in the business of farming and that the goods shown on this invoice will be used exclusively for that purpose.
Sec. Twsp._ Rge. W3
Any unpaid amount will be subject to a service charge of 1 Vz % per month for an APR of 18%
TOTAL PARTS
effective the date of this invoice-
1 hereby authorize the above repair work to be done along with the use of necessary materias. You and your employees TOTAL LABORmay operateon above ma
above machine fc:hine to secure the
r purposes of testing, inspection or delivery. 1 agree to a kamount of repairs thereto. It is understood thai this company
Mechanic's Lien is acknowledgedassumes no responsibility for loss
or damage by theft or fire to machine placed with them for storage, sale, repair or while field testing.
RECEIVED BY
MISC. CHARGES
SALES TAX
B O L T SE A DE R
1 8 9 . 7 534 . 4982 . 8018 . 98
8 . 9 18 . 34
6 9 . 0 01 1 . 4 94 1 . 6 9
4 . 2 02 . 583 . 121 .21
. 868 . 89
13 . 802 . 763 . 48
1 6 . 9 695 . 45
3 . 808 . 643 . 3 0
2 2 . 1 41 . 5 6
AMOUNT
PLEASE PAY vTHIS TOTAL W * * C O N T I N U E D * *
LF-1152C Ver. A CUSTOMER COPY GST 10259 2813 RT
JAY DEEEQUIPMENT LTD.
JAY DEE EQUIPMENT LTD. Service Invoicewww.jaydee.ca
MAPLE CREEK, SKPh: (306) 662-2233
SWIFT CURRENT, SK2674 South Service Rd. W., S9H 5J9
Ph: (306) 773-9351 Fax: (306) 773-2045
KINDERSLEY.SKPh:(306)463-2683
KYLE, SKPh: (306) 375-2302
LEADER, SKPh: (306) 628-3889 JOHN DEERE
SOLD TO:
INVOICE DATE
0 8 D E C 0 6
BRANCH
03
INVOICE NO.
5 4 3 2 3
M U R R A Y C O W I E PAGE sBOX 84 3 "
SALE TYPE p
F L A X C O M B E , S K S O L 1 E O O T H E RCUSTOMER NO. Q
4 6 3 3 0 3 9 0PURCHASE ORDER NO. PHONE NUMBER WORK ORDER NO. SEG. DATE OPENE
3 0 6 - 4 6 3 - 3 0 3 9 5 4 3 2 3 0 3 2 6 0 C T OMAKE MODEL SERIAL NO. EQUIP. NO. METER
J D 8 4 5 0 R W 8 4 5 0 H 0 0 3 9 2 3 4 W D T R A C T O 4 1 0 3 . 0DESCRIPTION
1 N R 8 5 0 2 7 P U S H R O D C Y1 N T Y 2 2 4 7 1 H O S E C L A M P
* * T O T A L L A B O R * *
» - - > S E G # 0 3 P R T 6 6 6 . 9 3 L A B 1 , 3 4 2 . 5 0 M S C* G S T / H S T *
C O O L I N G
D R A I N C O O L A N T . R E P L A C E A L L C O O L A N T H O S E S IR O O F . A D D C O N D I T I O N E R T O C O O L A N T . F I L L R A D
1 N TY16101V C O N D I T I O N E R1 N R 6 2 2 8 6 f^ RAD H O S E1 N R 5 7 3 8 8 H O S E1 N R 6 3 6 9 6 v/ ;::: RAD H O S E LO1 N R 7 2 6 3 9 ••?'••&; R A D I A T O R H CY2 N R 5 0 4 0 2 ;-;. H O S E1 N A 5 2 0 3 R H O S E1 N T Y 2 2 4 7 3 H O S E C L A M P3 N T Y 2 2 4 7 2 H O S E C L A M P
18 N L 11 1 0 9 2 OIL H O S E 102 1 2 N T Y 2 2 3 2 8 B U L K H O S E
1 N R 7 6 5 5 8 S L E E V E1 N R 5 5 4 2 6 S C R E W1 N C X T Y 1 6 0 3 6 C O O L A N T 10L
* * T O T A L L A B O R **
» - - > S E G # 0 4 P R T 1 4 0 . 9 3 L A B 1 5 0 . 0 0 M S C* G S T / H S T *
F U E L S Y S T E M
Terms: Payment due on receipt of invoice by cash, cheque. Visa, MasterCard, AgLine, or AgriCard. Any returns mustaccompanied by this invoice, be in a returnable condition, and may be subject to a re-stocking fee. Special order parts are non-returna
D 1 terby certify that 1 am engaged in the business of farming and that the goods shown on this invoice win be used exclusively for that purpc
Sec, Twsp. _ Rge. W3
Any unpaid amount will be subject to a service charge of 1 '/a % per month for an APR of 18% effective the date of this invoi
I hereby authorize the above repair work to be done along with the use of necessary materia s. You and your employemay operate above machine for purposes of testing, inspection or delivery. I agree to a Mechanic's Lien is acknowledgon above machine to secure the amount of repairs thereto. It is understood that this company assumes no responsibility for Icor damage by theft or fire to machine placed with them for storage, sale, repair or while field testing.
RECEIVED BY DATE
4 5 2 0 B 8 3 8 0 0 0 9 6 1 5 3 8 1 - 0 7
D SALES PRN
6 38AUTHORIZED BY
AMOUNT
7 . 481 . 2 5
. 0 0 T O
N C L U D I N G O N E S.
6 . 6 16 . 048 . 04
1 2 . 0 82 0 . 1 3
5 . 001 0 . 9 3
7 . 481 . 25
1 , 3 4 2 . 5 0
T A L 2 , 0 0 9 . 4 31 2 0 . 5 7
IN
6 . 6 16 . 0 48 . 0 4
12 . 082 0 . 1 31 0 . 0 01 0 . 9 3
1.41 1.411 . 25
. 33
. 099 . 491 . 67
2 5 . 7 6
. 00 TO
be DESCRIPTION)fe.
se.
TOTAL PARTS
36.
es TOTAL LABORedss
MISC. CHARGES
SALES TAX
3 . 755 . 94
19 . 089 . 491 . 67
2 5 . 7 61 5 0 . 0 0
T A L 2 9 0 . 9 31 7 . 4 6
AMOUNT
PLEASE PAY wTHIS TOTAL W * * C O N T I N U E D * *
LF-1152C Ver. A CUSTOMER COPY GST 10259 2813 RT
JAY DEE EQUIPMENT LTD.
www.jaydee.ca
Service InvoiceSWIFT CURRENT, SK
2674 South Service Rd. W., S9H 5J9Ph: (306) 773-9351 Fax: (306) 773-2045
JAY DEE MAPLE CREEK, SK KINDERSLEY, SK KYLE.SK LEADER, SKEQUIPMENT LTD. Ph: (306) 662-2233 Ph: (306) 463-2683 Ph: (306) 375-2302 Ph: (306) 628-3889 JOHN DEERE
SOLD TO:
M U R R A Y C ow IEB O X 8 4
F L A X C O M B
PURCHASE ORDER NO.
MAKE
JD
MODEL
8 4 5 0
E, S K S O L 1 E O
PHONE NUMBER
3 0 6 - 4 6 3 - 3 0 3 9SERIAL NO.
R W 8 4 5 0 H 0 0 3 9 2
PAGE
4SALE TYPE
O T H E R
CUSTOMER NO.
4 6 3 3 0 3 9 0
WORK ORDER NO.
3
5 4 3 2 3EQUIP. NO.
SEG
05
4 W D T R A C T O
METER
INVOICE DATE
0 8 D E C 0 6
sH
P
T0
DATE OPENED
0 1 N O V 0 6
4103
A
. 0
BRANCH INVOICE NO.
0 3 5 4 3 2 3
4 5 2 0 B 8 3 8 0 0 0 9 6 1 5 3 8 1 - 0 7
SALES PRN
38UTHORIZED BY
DESCRIPTION
P U L L ]
A N DN J E C T O R A N D T E S T . R E P L A C
C H A N G E F U L E F I L T E R S . B L E D
1 N R E 2 7 7 6 6
2 N A R 8 6 7 4 5
3 N E N V 5 0
L JF ]
NE
EF
. INS
AMOUNT
T A L L N E W L E A K O F F L
U E L S Y S T E M .
C YLTE
E N V1 N R E 1 1 3 2 5
6 N A R 7 3 8 4 7
* * T O T A L
» - - > S E G # 05 PRT 891 . 29
FI LTINJE
L A B O R
LiA B
* *
4
FE
R , F U E L
111
2 0
I LTER
R , F U E L
C T I O N
,7 6 . 2 5
C Y
M S C
12
120
. 00
. 55
. 69
. 50
. 36
. 75
TO* G S T / H ; S T * ;^ ; ;
; - : :,r ;-", " . : • " '
E L E C T R I C A L
R E P L A C E E T H E R S O L E N O I D . D I A G N O
A N DI
S E N T TO F A R M T R O N I C S . C O U L D
INE
111 .55
41 . 381 . 5 0
1 2 . 3 6724 . 50476 . 25
T A L 1 , 3 6 7 . 5 4
8 2 . 0 5
S D A S H P R O B L E M . R E M O V E D T A C H
NOT E E R E P A I R E D . W A S
R E P L A C E D .
1 N R E 4 8 3 1 0
1 N R E 6 6 8 3 5
* * T O T A L
S T A R T
M O N I
L A B O R
ING AT O R C O C Y
881 , 048
. 55
. 48
* *1 ;0 /S L A B O R & M A T E R
1 C O R E C H A R G E / C R E D I
» - - > S E G # 0 6 P R T 1 , 1 3 7 . 0 3 L A B 3
IT
5
A L .jj
6 . 2 5 MSC I
114
1 4 . 0 0 -
. 00
. 00 -
TO* G S T / H S T *
P O W E R T R A ] N
A D J U S T E D P A R K P A W L A N D T E S T
S C R E E N S , R E P L A C E F I L T E R S . F ]
Terms: Payment due on receiptaccompanied by this invoice, be in a
Q 1 herby certify that i am engz
Dr L L
R A I N H Y D R A U L I C O I L . C
W I T H N E W O I L .
of invoice by cash, cheque. Visa, MasterCard, AgLine, or AgriCard. Any returns must bereturnable condition, and may be subject to a re-stocking fee. Special order parts are non-returnable.
jged in the business of farming and that the goods shown on this invoice will be used exclusiveh/ for that purpose.
Sec. Twsp. Rge. W3
Any unpaid amount wil! be subject to a service charge of 1 '/i % per month for an APR of 18%
1 hereby authorize the above repair work to be done along withmay operateon above ma
above machine;hine to secure
forthe a
purposes of testing, inspectionmount of repairs thereto. It is ur
effective the date of
the use of necessary materia s. You and your
this invoice.
employeesor delivery. 1 agree to a Mechanic's Lien is acknowledgedderstoctd that this corr pany ass umes no responsit ility for loss
or damage by theft or fire to machine placed with them for storage, sale, repair or while field testing.
RECEIVED y
L E A N
DESCRIPTION
TOTAL PARTS
TOTAL LABOR
MISC. CHARGES
SALES TAX
8 8 . 5 5
1 , 0 4 8 . 483 5 6 . 2 5
. 001 1 4 . 0 0 -
T A L 1 , 3 7 9 . 2 8
8 2 . 7 6
AMOUNT
PLEASE PAY __w
THIS TOTAL W * * C O N T I N U E D * *
LF-1152C Ver. A CUSTOMER COPY GST 10259 2813 RT
JAY DEE EQUIPMENT LTD. Service Invoice
JAY DEEEQUIPMENT LTD.
www.jaydee.ca
MAPLE CREEK, SKPh: (306) 662-2233
SWIFT CURRENT, SK2674 South Service Rd. W., S9H 5J9
Ph: (306) 773-9351 Fax: (306) 773-2045
KINDERSLEY.SKPh:(306) 463-2683
KYLE, SKPh: (306) 375-2302
LEADER, SKPh: (306) 62&-3S89 JOHN DEERE
SOLD TO:
INVOICE DATE
0 8 D E C 0 6
BRANCH
03
INVOICE NO.
5 4 3 2 3
M U R R A Y C O W I EB O X 8 4
F L A X C O M B E
PURCHASE ORDER NO. 1
MAKE MODEL
JD 8 4 5 0
, SK SOL 1EO
PAGE S
5 " 4 5 2 0 B 8 3 8 0 0 0 9 6 1 5 3 8 1 - 0 7SALE TYPE p
O T H E RCUSTOMER NO. Q
4 6 3 3 0 3 9 0'HONE NUMBER WORK ORDER NO. SEG DATE OPENED SALES PRN
3 0 6 - 4 6 3 - 3 0 3 9SERIAL NO.
R W 8 4 5 0 H 0 0 3 9 2 3
5 4 3 2 3 0 7 0 1 N O V 0 6 3 8EQUIP. NO. METER AUTHORIZED BY
4 W D T R A C T O 4103 . 0
DESCRIPTION
2 N A R 9 9 6 6 12 N E N V 5 02 N R 7 1 0 6 51 N T Y 2 2 0 9 0
125 N E N V 51 N T Y 6 2 8 3
20 N E N V 1 01 N B 3 6 8 5 R2 N N 1 8 9 2 2 0
* * T O T A L
» - -> S E G # 07 PRT 668 ,16
FI
AMOUNT
L T E R T R A N 5 1 . 1 8E N V F I L T E R . 5 0P A C K I N G , FIL 3 . 2 8H Y G A R D 1 2 5 L 4 6 7 . 0 0E N V I R O O I L . 0 5H Y - G A R D 7 6 . 2 5E V I R O C O N 0 .100 -T ]
L A B O R
L A B
R I N G 3 . 2 8E B A N D 1 . 73
* *
1 0 2 . 3 61 . 0 06 . 5 6
4 6 7 . 0 06 . 2 5
7 6 . 2 52 . 0 03 . 283 . 4 6
5 0 2 . 5 0
5 0 2 . 5 0 M S C . 0 0 T d T A L 1 , 1 7 0 . 6 6* G S T / H S T ' * - : - .
O P E R A T O R S T A T I O N :
R E P L A C E C A B " F I L T E R v v V /1 N RE 1 2 7 9 3
* * T O T A L
» - - > S E G # 08 PRT 3 7 . 0 9
F]L A B O R
L A B
L T E R C A B 3 7 . 0 9
* *
7 0 . 2 4
3 7 . 0 91 8 . 7 5
" •" ;
1 8 . 7 5 M S C . 0 0 T O l T A L 5 5 . 8 4* G S T / H S T *
* T O T A L G S T / H S T * -
ij ^^ -,
GST No . 1 0 2 5 9 2 8 1 3
Terms: Payment due on receipt of invoice by cash, cheque, Visa, MasterCard, AgLiraccompanied by this invoice, be in a returnable condition, and may be subject to a re-stocking
e, or AgriCard. Any returns must be DESCRIPTION
3 . 3 5
4 0 9 . 3 7
AMOUNT3e. Special order pans are non-returnable.
n 1 herby certify that 1 am engaged in the business of farming and that the goods shown on this invoice wiH be used exclusively for that purpose.
Sec. Twsp. Rge. W3 TOTAL PARTS
Any unpaid amount will be subject to a service charge of 1 Y* % per month for an APR of 18% effective the date of this invoice.
I hereby authorize the above repair work to be done along with the use of necessary materials. You and your employees TOTAL LABORmay operate above machine for purposes of testing, inspection or delivery. I agree to a Mechanic's Lien is acknowledgedon above machine to secure the amount of repairs thereto, ft is understood that this company assumes no responsibility for lossor damage by theft or fire to machine placed with them for storage, s ale, repair or while field testing.
MISC. CHARGES
SALES TAX
3 , 5 4 1 . 4 3
4, 342 . 53
1 , 0 6 1 . 2 8 -
0 . 0 0DATE |
PLEASE PAY wTHIS TOTAL W 7 , 2 3 2 . 0 5
LF-1152C Ver. A CUSTOMER COPY GST 10259 2813 RT