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Business Order Form

Order Form
Date: 01/25/2010  
Time: 21:20
Customer
Credit Card
Internet

Name: Glenn Gould
Phone: (513) 444-5481
Shipping Address: 9474 Farmcourt
City: Dayton
State: Ohio
Zipcode: 45103

Card Number: 9998882
Expiration Date: 01/21/2006
Bank: Fifth Third
E Mail: jsmith@email.com
Items
Item #
Name
Description
Qty. Ordered
List Price
Sale Price
Qty. Shipped
Back Order
8961 CM Computer Monitor
1
89
80
1
0
8967 Pcable Power Cable
4
5
5
4
0
               
               
               
 
Item total
100
Shipping
20
Tax (6.6%)
6
Total Due
126