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

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

TYPE: Purchase

ACCT: Visa                   $ 75.58 USD

CARDHOLDER NAME : Amanda Rostkowski
CARD NUMBER     : ############4186
DATE/TIME       : 06 Mar 21 09:00:36
REFERENCE #     : 003 0783038 M
AUTHOR. #       : 01106G
TRANS. REF.     : GV-1615039236

    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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