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MOM <br />ENDLESS <br />OPPORTUNITY <br />AGFINITY MEAD AGRONOMY <br />360 3rd St - PO Box 627 <br />Mead, Co 80542 <br />970-535-4450 <br />BILL TO: 0000104505 <br />L G EVERIST INC <br />6254 CTY RD 26 <br />LONGMONT CO 80504 <br />FOR CHEMICAL EMERGENCY, SPILL, LEAK, FIRE, <br />INVOICE NUMBER: <br />K06266 <br />EXPOSURE OF ACCIDENT CALL CHEMTREC, DAY OR <br />INVOICE TOTAL <br />$4,084.18 <br />NIGHT, 1-800-424-9300 <br />INVOICE DATE, <br />5/12/2015 <br />$0.00 <br />SHIP DATE: <br />5/11/2015 <br />DUE DATE: <br />6/25/2015 <br />DISCOUNT DATE: <br />SHIP TO: 0000104505 <br />L G EVERIST INC <br />LICENSE #: <br />6254 CTY RD 26 EXPIRATION DATE: <br />LONGMONT CO 80504 SALESPERSON: C46 <br />PAGE 1 <br />ITEM# LOC DESCRIPTION EPA# QUANTITY UOM UNIT PRICE TOTAL PRICE_ <br />C217856 411 CORNERSTONE 5 PLUS 30 GAL 42750-59-1381 <br />C217807 411 BRASH 2.5 GAL 51036-308-9779 <br />MAY 12 2015 <br />FED./ST. TAX VS: <br />DELIVERY #: <br />P.O. #: 408 Scott <br />DELIVERED BY <br />RECEIVED BY <br />60.0000 GAL 21.00000 $1,260.00 <br />60.0000 GAL 43.89000 $2,633.40 <br />Cos -Cod /Z- <br />S• �5 Lazo �9�l? <br />INVOICE AMOUNT <br />$3,893.40 <br />PLUS SALES TAX <br />$190.78 <br />INVOICE TOTAL <br />$4,084.18 <br />LESS PREPAYMENTS <br />$0.00 <br />LESS PAYMENTS <br />$0.00 <br />LESS DISCOUNTS <br />$0.00 <br />AMOUNT DUE $4,084.18 <br />IF CASH OR CHECK PAYMENT IS RECEIVED BY <br />A DISCOUNT OF $0.00 APPLIES. PAY $4,084.18 <br />FINANCE CHARGE OF 1 3/401. PER MONTH (ANNUAL RATE OF 21 %) WILL BE ADDED TO UNPAID INVOICES ON THE 25TH DAY OF THE FOLLOWING MONTH <br />CUSTOMER COPY <br />