Tip $37.45 Amount $224.70 I agree to pay the above total amount according to the card issuer agreement. (Merchant agreement if credit voucher) Cardholder Signature 6E' Map of purchase location Customer Copy EFTA00468928

ted with collection of such nonrefundable amount including but not limited to reasonable attorney's fees. Cardholder Name (Required - Please Print) Cardholder Signature (ALWAYS REQUIRED) Please complete and Fax back to: Today's Date: LE EFTA00295604 EFTA00295605

Tip $32.00 Amount $192.00 I agree to pay the above total amount according to the card issuer agreement. (Merchant agreement if credit voucher) Cardholder Signature ; b1 Map of purchase location Customer Copy EFTA00465747

Tip $32.00 Amount $192.00 I agree to pay the above total amount according to the card issuer agreement. (Merchant agreement if credit voucher) Cardholder Signature ; b1 Map of purchase location Customer Copy EFTA00472279

Tip $32.00 Amount $192.00 I agree to pay the above total amount according to the card issuer agreement. (Merchant agreement if credit voucher) Cardholder Signature ; b1 Map of purchase location Customer Copy EFTA00472281

Tip $52.43 Amount $314.58 I agree to pay the above total amount according to the card issuer agreement. (Merchant agreement if credit voucher) Cardholder Signature ;`' Map of purchase location Customer Copy EFTA00497729

Tip $48.15 Amount $288.90 I agree to pay the above total amount according to the card issuer agreement. (Merchant agreement if credit voucher) Cardholder Signature ;`' Map of purchase location Customer Copy EFTA00465129

unt $240.75 $48.15 $288.90 I agree to pay the above total amount according to the card issuer agreement. (Merchant agreement if credit voucher) Cardholder Signature ; b1 Map of purchase location Customer Copy EFTA00465135

$160.50 Amount $963.00 I agree to pay the above total amount according to the card issuer agreement. (Merchant agreement if credit voucher) 6E' Cardholder Signature 6E' Map of purchase location Customer Copy EFTA00493701

$44.94 Amount $269.64 I agree to pay the above total amount according to the card issuer agreement. (Merchant agreement if credit voucher) go, Cardholder Signature 6E' Map of purchase location Customer Copy EFTA00497543