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Mission Uniform Service <br />7520 Reese Rd <br />Sacramento, CA 95828-3707 <br />Invoice #:508266397 <br />Page: <br />Customer #: <br />5 of 5 <br />261704 <br />9/21/2018Date: <br />Purchase Order #: <br />Payment is Due:October 10th <br />Delivery Plant: <br />Delivery Days: <br />4801 I <br />....F.. <br />Delivery Stop:Rt 22 - 90 <br />BELKORP AGRICULTURE-STOCKTON <br />1120 W Charter Way <br />Stockton, CA 952061107 <br />Deliver To <br />Customer Invoice <br />PH 916-423-3179 <br />Remit To: <br />Cancelled Customer <br />Line Emp Item Identity Invty Qty Amount Adj <br />Qty <br />Adj Amount <br />117 623 Sh-Crw-Jdeere Ch/Gry DAVE EMBL 5 5.00 * <br />118 623 Sh-Crw-Jd-Ch/Gry-Ls DAVE 6 1.98 -1.98 <br />119 623 Sh-Crw-Jd-Ch/Gry-Ls DAVE PREP 6 15.00 <br />120 623 Sh-Crw-Jd-Ch/Gry-Ls DAVE EMBL 6 6.00 * <br />121 623 Sh-Crw-Jd-Ch/Gry-Ls DAVE EMBL 6 6.00 * <br />Subtotal $513.58 Adj <br />Subtotal -13.09 <br />Sales Tax $3.96 *Adj Tax <br />Prebill Total $517.54 Adj Total -13.09 <br />Adjust Amount ($13.09) <br />Amount Due $504.45 <br />Remarks: <br />NA #5302IJB $1.00 EMB 534B $1.00 PREP $2.00 <br />Received 9/21/2018 7:35:30 AM: <br />Signed: