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RECEIPT 10/15/2012
DULLES GLASS AND MIRROR
9151 EUCLID AVENUE
Mannassas , VA 20110
Phone 703-361-9994
info@dullesglassandmirror.com
Transaction Type : Sale
Authorization Code : 202880
AVS Result : Y - Match. Street address and 5•dlgit postal code match.
Total : 4282.58 USD
Cardholder Information
Name
Credit Card Type : American Express
Credit Card Number: xq x*4*.: quad 2037
Level II Fields
Tax Exempt : NO
hups://e6c.cybersource.com/ebc/virtualterminal/PrintSingleReceiptLoad.do 10/15/2012
EFTA00521017