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&Qom, BOLINGER & QUEEN <br /> �'�+' 32874 J ROAD <br /> 41166 HOTCHKISS, CO 81419 <br /> PV[Pipe&Trym (970) 872-3371 <br /> MUM Mee <br /> 1154724371 97.4235030 a <br /> DOCUMENT NUMBER PAGE NO <br /> A00724/1 1 <br /> CUST NO:*1 JOB NO: 000 CLERK SALESPERSON DATE l TIME <br /> BILL TO: *"' CASH i`** 58 913115 4 05 <br /> TERMINAL REFERENCE <br /> 552 ORDR* 724 <br /> INVOICE <br /> SHIP VIA PO NUMBER <br /> DUE DATE TERMS <br /> 9/4115 CASH/CHECK/BANKCARD <br /> TAX <br /> 021 HOTCHKISS GOVERNMENT <br /> LN# ITEM UM DESCRIPTION ORDERED B/0 SHIPPED PRICE /PER EXTENSION <br /> 1 12150200 IF 15"DOUBLE-WALL HDPE N-12 100 100 12 34 ILF 1234 00 N <br /> 64144.14i slePL 9161 -41‘4A444"'",,: 44/vt1.4) <br /> fly <br /> D <br /> M-t99`j- o/7 <br /> m 1 co�a�or., <br /> - - <br /> 1 a 5 z x- gt44,4- <br /> f <br /> ()it int <br /> P r� <br /> TAXABLE 000 <br /> SUBTOTAL 1234 00 <br /> NON-TAXABLE 1234.00 <br /> ••PAID IN FULL" 1234 00 <br /> SUBTOTAL 1234.00 <br /> TAX AMOUNT 00 <br /> TOTAL AMOUNT 1.234 00 <br /> BANKCARD PAYMENT <br /> I 1IIIIIu uuu 1I BKCRD# X7622 1234 00 <br /> XR 000724miI1911606408815778 xAO <br /> Signature <br /> I nature Re uired <br />