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| Payment Request
Submitted |
Thank you for your
payment.
The following payment request has been
submitted. |
| Please print this page or
please refer to the reference ID when communicating to
us regarding this transaction. |
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| Reference
ID: |
1658538054
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| Date and
time: |
05/29/2004 10:21:52 (CDT)
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| Account
number: |
064-4335852-2216-2 |
| Account
type: |
Individual |
| Payment
type: |
Invoice: 1243561-2216-6 |
| Payment amount: |
$49.41 |
| Payment
method: |
Master
Card ************0110 |
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