Koffler SalesI/
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MIAMI SHORES VILLAGE
VISA CARD PAYMENT VOUCHER
1. Attach original credit card receipt.
2. Submit one form per credit card receipt.
3. Submit to Finance Department within 5 business days of receipt.
Date of purchase: S X41-7 Amount of purchase: /3 l 7�2 s8
Cardholder Name
L,,& W
Name of Vendor: 0 +-1-1-e r SCL !i5
Description of Purchase / Notes: sof) l Less °r 100A 60-f[ - lei--s
tree
lqrg�XMPin-
Budget Code: r 4 J a_ S — �' y 10
These purchases were actually incurred as necessary business expenses and are true and
correct as to every material matter.,
Submitted By:
Approved:
9/18 l zat7
Card Holde esignee Signature Date
Departmer}t'�ead Signature
Payment Authorization:
Finance Director Signature
Distribution: Department Heads /Designee
9 18}zdt
Date
Date
Updated: 06/19/2017
.%-%W
Kevin Lystad
From: CUSTOMERSERVICE @KOFFLERSALES.COM
Sent: Monday, September 18, 2017 11:33 AM
To: Kevin Lystad
Subject: KOFFLER SALES CO. Transaction Receipt
General Information
Merchant Account: KOFFLER SALES CO.
Date/Time : 09/18/2017 10:32:33 AM CDT
Transaction Information
Order ID: 209523MIA
Transaction Amount : $1,172.58
Transaction ID : 3789248368
Authorization Code : 060033
Transaction Type : Card Sale
Response : AP
AVS Results : 5- character Zip match only
CSC Results:CVV2 /CVC2 Match
Customer Billing Information
First Name: KEVIN
Last Name: LYSTAD
Address: 9990 NE SECOND AVENUE
City: MIAMI SHORES
State: FL
Zip Code : 33138
Country : US
Phone:
Email :
Customer Shipping Information
First Name
Last Name
Address:
City :
State
Zip Code
Country : US
Email :
1
d104, oft
2067 Wineridge PI Suite F
Escondido CA 92029 USA
800- 747 -6095
Bill To
Koftler Sales Company
785 Oakwood Rd Ste C -100
Lake Zurich. 11, 60047
Ups # 620720
Packing Slip
Date Invoice #
9/5/2017 066395
Ship To
Miami Shores Police Dept
Kevin Lystad
9990 NE Second Ave
Miami Shores, FL 33138
305 -759 -2468
Salesperson P.O. Number Ship Via Ship Date Ordered By
3
LISA 209523MIA UPS 2 Day 9/5/2017
Quantity Item No. Description U/M
2 OD65 -26 Flood Barrier 5' Pack of 26
Shipping Tracking 129817410268052042
I 1Z9817410270759856
20x12x12 22# each
COPY - DY�gll'1G► V,1GS riO IyG
MIAMI SHORES VILLAGE
VISA CARD PAYMENT VOUCHER
1. Attach original credit card receipt
2. Submit one form per credit card receipt
3. Submit to Finance Department within 5 business days of receipt.
Date of purchase: q L,5 201-1 _
Cardholder
Amount of purchase: /3 / 7�2 s8
Name of Vendor: K041er- srItS
Description of Purchase / Notes: so nAtsC 100A b�friers
Budget Code: �� -a - osas - mss- sa s - sa - 10
These purchases were actually incurred as necessary business expenses and are true and
correct as to every material matter.,
Submitted By:
Approved:
Card Holde esignee Signature Date
Departme dread Signature
Payment Authorization:
Finance Director Signature
9/18hd
Date
Date e)
Distribution: Department Heads /Designee Updated: 06/19/2017
Day
2067 Wineridge P) Suite F
Escondido GA 92029 USA
800- 747 -6095
Bill To
Koffler Sales Company
785 Oakwood Rd Ste C -100
Lake Zurich, !L 60047
Ups # 620720
Ship To
Packing Slip
Date Invoice #
9/5/2017 066395
Miami Shores Police Dept
Kevin Lystad
9990 NE Second Ave
Miami Shores, FL 33138
305- 759 -2468
Salesperson
P.Q. Number
Ship Via
Ship Date
Ordered By
LISA
209523MIA
UPS 2 Day
9/5/2017
Quantity
Item No.
Description
UIM
2
QD65 -26
Shipping Tracking
i
Flood Barrier 5' Pack of 26
129617410268052042
1Z9817410270759856
20x1202 22# each
t�
Kevin Lystad
From: CUSTOMERSERVICE @KOFFLERSALES.COM
Sent: Monday, September 18, 2017 11:33 AM
To: Kevin Lystad
Subject: KOFFLER SALES CO. Transaction Receipt
General Information
Merchant Account: KOFFLER SALES CO.
Date/Time : 09/18/201710:32:33 AM CDT
Transaction Information
Order ID: 209523MIA
Transaction Amount: $1,172.58
Transaction ID: 3789248368
Authorization Code: 060033
Transaction Type: Card Sale
Response: AP
AVS Results: 5- character Zip match only
CSC Results: CVV2 /CVC2 Match
Customer Billing Information
First Name : KEVIN
Last Name: LYSTAD
Address: 9990 NE SECOND AVENUE
City: MIAMI SHORES
State :FL
Zip Code: 33138
Country: US
Phone:
Email:
Customer Shipping Information
First Name:
Last Name
Address:
City:
State
Zip Code:
Country: US
Email:
1