# PIAGET

Jun 25, 2012

<table><tr><th>Purchased by</th><th></th><th></th><th></th></tr><tr><td>Ms</td><td></td><td></td><td></td></tr><tr><td>301 E 66th Street</td><td></td><td></td><td></td></tr><tr><td>New York, NY</td><td>10065 6205</td><td></td><td></td></tr><tr><td>USA</td><td></td><td></td><td></td></tr><tr><td>Invoice number</td><td>: 306004120625005</td><td></td><td></td></tr><tr><td>Service order no:</td><td>: 10860717</td><td></td><td></td></tr><tr><td>Your model:</td><td>PROTO XI. YG AUTO LEATHER STRAP</td><td></td><td></td></tr><tr><td>Serial N</td><td>:843109</td><td></td><td></td></tr><tr><td>Sold by</td><td>: Gigi Krisak 106769</td><td></td><td></td></tr><tr><td>Audit cupy</td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>Quantity</td><td>Tota. Amonint</td></tr><tr><td>Complete service</td><td></td><td>1</td><td>975.00</td></tr><tr><td>Subtotal</td><td></td><td></td><td>975.00</td></tr><tr><td>Tax</td><td></td><td></td><td>86.54</td></tr><tr><td>Total</td><td></td><td></td><td>1,061.54</td></tr><tr><td>Means of Payment</td><td>Americant xpress Amit 1.06154</td><td></td><td></td></tr><tr><td></td><td>13406 MM17H</td><td></td><td></td></tr></table>

Client's signature. The signature is obscured by a black rectangle.

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