Credit Card (2) Receipt Page 1 of 1 TRANSACTION SUMMARY TRANSACTION TYPE: SALE PA YMENT ITEM NPS Convenience Fee Mise Cash TOTAL: REFERENCE NUMBER AMOUNT $1.50 $50.00 $51.50 .............................................................................................................................................................................................................................................1 TOWN OF WAPPINGER 20 Middlebush Rd Wappingers Falls,NY 12590 845-297-4158 SALVATORE POLIANDRO .............................................................................................................................................................................................................................................. Mise Cash Total: 207133 01/191201209:32:50 EST Credit Card CardNwnber: ............8856 04166B 00506478 $50.00 $50.00 Transaction Number: Date Processed: Transaction Type: MASTERCARD - Swiped Authorization: Reference Number: " .1 1 agree to pay abm,.,itotal.arnount acCOjding. to. the cffdjfsu~greement. J (.'i,.'-; / / i/V\../l Signature: , C' ./ NPS MUNICIPA Y CONV FEE - TOWN OF WAPPINGER, NY 400 Technology Way Scarborough,ME 04074 877-564-5656 SALVATORE POLlANDRO .............................................................................................................................................................................................................................................. Transaction Number: Date Processed: Transaction Type: MASTERCARD - Swiped Authorization: Reference Number: 207133 01/19/201209:32:50 EST Credit Card CardNumber: ............8856 04193B 00506479 $1.50 $1.50 Convenience Fee Total: ? / J I agree to pay above tota7!,Zy!ordmg'to)heJ:ard Ii:e, a~7e ent & understand this convenience fee will be charged to allow my payment via credIt card Signature I L ! /! I c/ / I/{; (,( Printed: 01/19/2012 09:32:54 https://trx.npspos.com/payapp/app? component=%24 DirectLink&page=Receipt&service=d... 1/19/2012