Credit Card
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
TOWN OF WAPPINGER
20 Middlebush Rd
Wappinger, Falls,NY 12590
845-297-4158
BRIAN P LUHRS
Transaction Number:
Date Processed:
Transaction Type:
DISCOVER - Swiped
Authorization:
Reference Number:
Mise Cash
Total:
222050
03/06/2012 11 :28:02 EST
Credit Card
CardNwnber: *********.**3810
00682R
00788728
$50.00
$50,00
I agree to pay above total 8:tl10unt according to the card issuer agreement.
Sihmature' ~.-::---~. . _.;~~;:2
NPS Ml!NIClPA Y CON V FEE - TOWN OF WAPPINGER, NY
400 Technology Way
Scarborough, ME 04074
877-564-5656
BRIAN P LUHRS
Transaction Nwnber:
Date Processed:
Transaction Type:
DISCOVER - Swiped
Authorization:
Reference Number
Convenience Fee
Total:
222050
03/06/2012 1128:02 EST
Credit Card
CardNumher: ************3810
00689R
00788730
$1.50
$1.50
I abrree to pay above tot,~~ ~~~~.~!l~UJcJ';.oIdinK~~..~~.~.:~~rd"issuer agreement & understand this convenience fee will be charged to allow my payment via credit card.
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Signature: . ... / . <.., ---? ~. ... .
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Printed: 03/06/;012 II :28: -.---..... =. ... ....
https://trx.npspos.com/payapp/app ?cornponent=%24 DirectLink&page= Receipt&service=dir... 3/6/2012