Norgetown PropaneI ET OW' f'iiE AIlt WkJH7
005 NW 119 ST
NORTH MIAMI, FL 33168
J05-403-2277
09 00 _)u17
Card
Chip Card.
AID:
ATC:
TC:
SEQ
Batch +
Ti a%
Approval
TRANS ID.
EnGy Me1tiod
Mode:
Tax Amotmt:
Cust Code:
0916,57
CREDIT CARD MIAMI SHORES VILLAGE
VISA AD)U5I SALE VISA CARD PAYMENT VOUCHER
X4AXXXXXXXX9760
VISA CRFAIT
A0000006031010 1. Attach original credit card receipt.
0022 2. Submit one form per credit card receipt.
F39B�?Is�,93SAa8B 3. Submit to Finance Department within 5 business days of receipt.
113
36 r
0'9368 j
Dip Read
L:uei - PIN Verified
$0.00 �'w'►
123+
SALE AMOUNT $09,00
s:
THANK YOU FOR COMING
NJE APPRECIATE TOUR BUSINESS
GJS1 OMER COPY
Amount of purchase
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Budget Code: zsz, ; � r 0 S_ d �' C) F S �f__ ,_�2 310
These purchases were actually incurred as necessary business expenses and are true and
correct as to every mater I matter.
Submitted �/o I
Approved:
rporate Card Holder Signature
Department Head Signature
Payment Authorization:.
Finance Director Signature
Date
10 (2q
Date
Date 0
Distribution: Department Heads /Designee Updated: 05/24/2016