========== TRANSACTION RECORD ==========
GERMED LTD

NEW HYDE PARK, NY
United States
WWW.GERVETUSA.COM

TYPE: Purchase

ACCT: Visa                  $ 118.34 USD

CARDHOLDER NAME : Susan H Guiet
CARD NUMBER     : ############5506
DATE/TIME       : 26 Jul 21 11:01:20
REFERENCE #     : 003 0907156 M
AUTHOR. #       : 090121
TRANS. REF.     : GV-1627311680

    Approved - Thank You 100


Please retain this copy for your records.

Cardholder will pay above amount to
card issuer pursuant to cardholder
agreement.
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