Page | of 1 RECEIPT 10/15/2012 DULLES GLASS AND MIRROR 9151 EUCLID AVENUE Mannassas , VA 20110 Phone 703-361-9994 info@dullesglassandmirror.com Transaction Type: Sale Authorization Code : 202880 AVS Result: Y - Match. Street address and 5-digit postal code match. Total: 4282.58 USD Cardholder Information Name Credit Card Type: American Express Credit Card Number: #########222037 Level II Fields Tax Exempt: NO https://ebc.cybersource.com/ebc/virtualterminal/PrintSingleReceiptLoad.do 10/15/2012 EFTA00521017