Credit Card
Receipt
page 1 ot 1
TRANSACTION SUMMARY
Transaction Type: Sale
Payment Item
Reference ID
Amount
Mise Cash
$13.50
NPS Convenience Fee
$1.50
Total:
$15.00
Town of Wappinger
20 Middlebush Rd
Wappingers Falls, NY 12590
845-297-4158
VENUS BERNARDI
MASTERCARD - Swiped
CardNumber: ************6339
Card expo date: **/**
Auth #: 07756B
Ref#: 00275867
Timestarnp:05/03/2010 11 :02:59
Mise Cash $13.50
Total
I amount according to the card issuer agreement.
Sign:
..................__~_ f
I ... "1_....................................._~..- .,
NPS Municipay Conv Fee - Town of Wappinger, NY
400 Technology Way
Scarborough, ME 04074
877-564-5656
VENUS BERNARDI
MASTERCARD - Swiped
CardNumber: ************6339
Card expo date: **/**
Auth #: 07750B
Ref#: 00275866
Timestamp:05/03/201O 11 :02:59
~y
............."........,
Convenience Fee $1.50
Total
I agree to ~ay above to amount according to the card issuer agreement & understand this convenience fee will be
charged t 'allow my payment via credit card.
I -c? (a:L-_..~(
Sign:
.....................__ 4 .."
1. ... ,_........................................... ....
L ''I. .'1 ____.....................
Printed: 05/03/2010 11:03:05
https:/ lbeta2.municipay .com:8443/app?component=%24DirectLink&page=Receipt&service... 5/3/2010