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I <br /> I � . <br /> DIAMOND <br /> ICE <br /> Special Event Form <br /> Invoice#: <br /> CUSTOMER <br /> • ' • <br /> Organisation:Wendt Construction <br /> Contact: Don Title: suP�inrt�� <br /> Phone: 993-2217 Fax: E-Mail: <br /> Address: ?0 �3X )Ifo City: LoA', State: Zip: CIS-2V> <br /> a <br /> Billing Address: City: State: Zip: <br /> I <br /> D_ INFORMATION <br /> Event Contact: Don Phone: 993-2217 <br /> Delivery Date:Jan 13, 2014 Time: lam Day: Monday <br /> Special Instructions: <br /> Delivery Address: 550 West Valpico Rd `City:Tracy State: CA Zip:95376 <br /> I <br /> Pick-Up Date: Time: Day: <br /> Special Instructions: <br /> �777=­ <br /> PAYMENT INFORMATION <br /> 7 Days Prior to Event: Check No: <br /> Credit Card: Type: . Name on Card: <br /> e • r e • • <br /> Product Quantity Price Total <br /> Dry Ice 660 1.15 759.00 <br /> Tax 8.5% 64.52 <br /> $ 823.52 <br /> Order Placed By: Date: <br /> Order Received By:I('(D 1 W".e- Printed: <br />