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SALES RECEIPT

654789
Receipt Number: _________________
04/03/2023
Date: _________________
Insurance Auto Auctions
Merchant Name: ___________________________
800-323-0698
Merchant Phone Number: ___________________________
2040 E Algonquin Rd STE 501
Merchant Street Address: ___________________________
Schaumburg, IL 60173-4160
City/State/ZIP: ___________________________
Sold to:
Name: _________________
Company Name: _________________
Street Address: __________________________________
Brownsville, TX 78521
City/State/ZIP: _________________
Phone Number: __________________
Description Quantity Price/Unit Line Total

5,000.00 5,000.00

Subtotal: $_________________
Discount: $_________________
Sales Tax: $_________________
Total: $_________________
Payment Method: _________________ Amount Paid: $_________________
Card/Check Number _________________

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