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Credit Card
Page 1 of 1 Receipt TRANSACTION SUMMARY TRANSACTION TYPE: SALE PAYMENT ITEM NPS Convenience Fee Mise Cash TOTAL: REFERENCE NUMBER AMOUNT $1.50 $50.00 $51.50 .............................................................................................................................................................................................................................................. TOWN OF WAPPINGER 20 Middlebush Rd Wappingers Falls,NY 12590 845-297-4158 JUAN VASQUEZ ...................................................................................................................................................................................................................... Transaction Nwnber: Date Processed: Transaction Type: MASTERCARD - Swiped Authorization: Reference Nwnber: Mise Cash Total: 188471 11/01/201111:42:37 EDT Credit Card CardNumber: ...........***5792 07160Z 00724299 Check $50.00 $50.00 I agree to pay above to~ amount according to the card issuer agreement. Signature: ~ C/, ~ C/ NPS MUNICIPA Y CONY FEE - TOWN OF WAPPINGER, NY 400 Technology Way Scarborough,ME 04074 877-564-5656 JUAN VASQUEZ ......................................................................................................................................................................................................................... Transaction Nwnber: Date Processed: Transaction Type: MASTERCARD - Swiped Authorization: Reference N wnber: Convenience Fee Total: 188471 11/01/2011 II :42:37 EDT Credit Card CardNumber: ************5792 07160Z 00724298 Check $1.50 $1.50 I agree to pay ab070unt according to the card issuer agreement & understand this convenience fee will be charged to allow my payment via credit card. Signature: ............ c/o C~ {/ Printed: 11/011201111:42:41 https:/ Itrx.npspos.comlpayapp/app?component=%24 DirectLink&page=Receipt&service=d... 11/l 120 11