RECEIPT
DULLES GLASS AND MIRROR
9151 EUCLID AVENUE
<u>Mannassas VA 20110 Phone</u> 

10/15/2012

Transaction Type : Sale

Authorization Code : 202880 AVS Result : Y 'latch. Street address and 5-digit postal code match.

## Total : 4282.58 USD

## Cardholder Information

Name: 
Credit Card Type : American Express
Credit Card Number : ************2037

Level II Fields

Tax Exempt : NO