| |
| |
| Delivery Information |
| First Name: |
Johnathan |
Last Name: |
Doevermahn III |
| Street Address: |
95 Wall St |
Apt, Building, etc: |
Apt #606 |
| Telephone: |
555-555-5555 |
Phone Extension: |
(none) |
| Delivery Notes: |
Please leave with roomate |
Email: |
j.doe@gmail.com |
| |
| Billing Information |
|
|
| First Name: |
Johnathan |
Last Name: |
Doevermahn III |
| Address: |
95 Wall St |
Address Line 2: |
Apt # 606 |
| Billing City: |
Jersey City |
State: |
NJ |
Zip Code: |
07748 |
| Card Number: |
***********5555 |
|
|
Exp: |
05/2010 |
| |
| Order Details |
Product Code: B = bottles C = cans K = keg k = 1/4 keg |
| 10 |
Miller Light |
24 B @ |
$20.00 |
12 |
Wilwalke's Best Light |
30 C @ |
$12.95 |
| 5 |
Coca-Cola Classic |
24 C @ |
$8.00 |
15 |
Wilwalke's Best Light |
30 C @ |
$12.95 |
|
|
| |
| 11 Nov 2008, as soon as possible |
| |
| $72.45 |
| $4.75 |
| $2.00 |
| $4.75 |
| $82.75 |
| Thank you for choosing Thirsty Joe's! |
| Order #60652 |
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