l - CUSTOMER ORDER FORM Name Address City Phone Mobile Shipping Address (at different from above) oy a Country NWZ 5 lecess Moustt| Wax 44,950.00 | IeLeMentr Cac an i C2l2cl 12) — __| Ls ELEMENT PACK lt | RATES, | | ELEMENT Pace eo $$} __ [RAAS=SO | Lieve Ment Yaa’ Yeome IR SGOOD .OO | —_ — ; imc. oman Bi ‘ ; | LNA oe j } ay by payments All deposits are non refundable. Ralences are duc in GO days Minemum 20% deposit IOTA | aii . a | ciciaks Mjpshesidaationdamnen WA 450.00 | All sa are final No sefur NOTE | | | Customer Signatur ate | 2. Zw \\Z. | | Art Consultant | LERIES* O or O out o o t D &-Roor Orvs Oo IMedis OlEmel QO | — - = . = — — | IKSOHO. SUUNGIENEA SmnUROGIA RUNS exhataeiadies EFTA00558597

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12/26/2012 13:53:09 Merchant ID: 000000001582241 Terminal ID: 02632360 6317683621 CREDIT CARD AMEX SALE CARD # YOOOOOOXXKKX3003 INVOICE 0008 Batch #: 000710 Approval Code: 241827 Entry Method: Manual Mode: Online Avs Code: YY Card Code: M SALE AMOUNT $4450.00 I agree to pay above total amount according to card issuer agreement. ALL SALES FINAL- NO REFUNDS MERCHANT COPY 12/26/2012 13:53:09 Merchant ID: 000000001582241 Terminal ID: 02632360 6317683621 CREDIT CARD AMEX SALE CARD # KOOOOOOIOOK3003 INVOICE 0008 Batch #: 000710 Approval Code: 241827 Entry Method: Manual Mode: Online Avs Code: YY Card Code: M SALE AMOUNT $4450.00 ALL SALES FINAL- NO REFUNDS Me CUSTOMER COPY EFTA00558598