========== TRANSACTION RECORD ==========
GERMED LTD

NEW HYDE PARK, NY
United States
WWW.GERVETUSA.COM

TYPE: Purchase

ACCT: Visa                  $ 314.44 USD

CARDHOLDER NAME : Christopher Jacobsen
CARD NUMBER     : ############0773
DATE/TIME       : 05 Sep 20 00:25:02
REFERENCE #     : 003 0919006 M
AUTHOR. #       : 05090G
TRANS. REF.     : GD-1599279902

    Approved - Thank You 100


Please retain this copy for your records.

Cardholder will pay above amount to
card issuer pursuant to cardholder
agreement.
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