Case File
efta-efta00520753DOJ Data Set 9OtherCustomer Name:
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00520753
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:
Address:
TOP HAT UNIFORM INC.
dba TOP HAT IMAGEWEAR
230 DUFFY AVENUE — SUITE E
HICKSVILLE. NY 11801
TEL:
FAX:
EMAIL
CREDIT CARD FORM
9
F
at / Neefi Xoyi,407 /00.21
Credit Card (circle one): Visa
Mastercard
Credit Card #:
Exp. Date:
ay.t.3
V Code: 0/96 29
MillIMIIMIMI
Name on Account:
Address on Account:
.9 L' ?id
fitee
f
Amount to be charged: S teo. Op
Apply to Invoice/Sales Order or Purchase Order #
4:U 7 l7
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SAA%
Z
Authorized by: /at
EFTA00520753
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