<signature> Sea Specs

SeaSpecs

TM

12865 West Dixie Highway
North Miami, FL 33161

Date Invoice #

Bill To
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9 East 71 St
NY, NY 10021

Ship To
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9 East 71 St
NY, NY 10021

Clerk: SM
Order Number: <empty>
Terms: PRESCRIPTION
Rep: <empty>
Ship Date: ██████
Ship Via: <empty>
Tracking number: <empty>

<table><tr><th>Quantity</th><th>Item Code</th><th>Description</th><th>Price Each</th><th>Amount</th></tr><tr><td>2</td><td>Rx- SINGLE VI...</td><td>PRESCRIPTION - SINGLE VISION - BLACK Frame/GREY Lens
2nd Pair BLACK Frame / BROWN Lens</td><td>195.00</td><td>390.00</td></tr><tr><td>1</td><td>RDGRY1</td><td>SunFire Specs - Free</td><td></td><td></td></tr><tr><td></td><td>Shipping</td><td>Shipping - US Priority Mail</td><td>13.95</td><td>13.95</td></tr><tr><td>Enjoy your</td><td>SeaSpecs!</td><td></td><td>Total</td><td>$403.95</td></tr></table>