Case File
efta-efta00520749DOJ Data Set 9OtherCustomer Name:
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00520749
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
Customer Name:
TOP HAT UNIFORM INC.
dba TOP HAT IMAGEWEAR
230 DUFFY AVENUE — SUITE E
HICKSVILLE NY 11801
TEL:
FAX:
EMAIL:
CREDIT CARD FORM
Address: 9 z=-Of
Wx/ ,f6-ez`/
/1/2 /(o',2/
Credit Card (circle one): Visa
Mastercard
Credit Card #:
Exp. Date: I' 7
PIIIIMMW__
Name on Account:
Address on Account:
.9 Fad 74
71 S Z1 „r/ret if46,/ 03,/, Ny 7o.tf
,,
V Code:
766e9
Amount to be charged: S
Apply to Invoice/Sales Order or Purchase Order #
J 6
<.,L
Authorized by: ,
7?•
,7a.
EFTA00520749
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