Store: 9 Register: 37553 Date: 06/21/2025 Time: 17:26 Ticket: 144881 Salesperson: 862079404 Cashier: 6599196

Item Qty Price Amount

DOUBLE-BREASTED KNIT BLAZER 14540965997 1 $350.00 350.00 0% OFF ($0.00)

Subtotal 350.00 Tax 35.00

Total 385.00

CARDHOLDER COPY Date 06/21/2025 Time 17:26 Card ****9898 PAN seq. 20 Pref. name Visa Debit Card type visastandarddebit Payment method visa Payment variant visastandarddebit Entry mode CHIP CVM res. VERIFIED BY DEVICE AID A50204955343 MID 587027751815 TID 4366886354