action Type: VISA SALE Transaction Amount: 41995.00 Auth Code: 051420 AVS Reply: IR) RETRY Ticket 0: 56862249 Date: 09/27/12 04:45:04 PM 07(9- %lel' ;1' lac 40410.eThort-ac CARCNEMBER ACKNOWLEDGES RECEIPT OF GOODS AND/OR SERVICES IN THE AMOUNT OP THE TOTAL SHOWN HEREIN AND AGREES TO PERFORM T