005 SERVICE ESTABLISHMENT CLAIM FORM Enclosure:NO CM Name: Disputed ant: 6.48 let Charge Date: October 20, 2005 1st Charge Amount: $3,906.48 RA/Ref: 0 Inv/ROC Number: CM Account: Foreign Amount: 2nd Charge Date: 2nd Charge Amount: $.00 RA/Ref: Inv/ROC Number: Dispute: Our mutual customer