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RECEIPT 10/15/2012
DULLES GLASS AND MIRROR
9151 EUCLID AVENUE
Mannassas VA 20110
Phone
Transaction Type : Sale
Authorization Code : 202880
AVS Result : 'latch. Street address and 5-digit postal code match.
Total : 4282.58 USD
Cardholder Information
Name
Credit Card Type : rk - 1'1 r ..•
Credit Card Number : r r • ••• r:20
Level II Fields
Tax Exempt : NO
https://ebe.cybersource.com/ebc/virtualterminal/PrintSingleReceiptLoad.do 10/15/2012
EFTA_R1_01218105
EFTA02316960