Delivery Receipt

Customer Information

Name Elroy Faudrie Receipt Number #I

Email oflacke2@dailymotion.com Delivery Date January 16, 2009

Phone Number (48) 132-6456 Delivery Address 7 Crescent Oaks Terrace

New Orleans, Lo, 70160

Address 7 Crescent Oaks

Terrace New Orleans,
Lo, 70160

Order Details

Item Description Quantity Unit Price Amount

1 Product A 10 $50 $500

2 Product B 10 $30 $300
3 Product C 5 $40 $200
4 Product D 20 $20 $400
5 Product E 15 $50 $750
6 Product F 10 $15 $150
7 Product G 5 $50 $250
8 Product H 10 $30 $300

Received By Nina Threadgill Subtotal 8140

Signature Delivery Charge 7

Total Amount 3355

2142 Coffman Alley, Bowling Green, KY, 42270

(123)1234567 - info@abcdeliv.com - www.abcdeliv.com

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