| Order Number: |
00000001 |
| Order Date: |
29-Jun-2004:02:06 |
| Order Status: |
|
|
| |
| Bill To |
Ship To |
| Name: |
Site Administrator |
| Company: |
|
| Address 1: |
1 Apache Street |
| Address 2: |
|
| City: |
Apache |
| State/Region: |
GA |
| Zip: |
30307 |
| Country: |
USA |
| Phone: |
555-555-1212 |
| Fax: |
|
| Email: |
noreply@phpshop.org |
|
| Name: |
Site Administrator |
| Company: |
|
| Address 1: |
1 Apache Street |
| Address 2: |
|
| City: |
Apache |
| State/Region: |
GA |
| Zip: |
30307 |
| Country: |
USA |
| Phone: |
555-555-1212 |
| Fax: |
|
|
|
| |
| Quantity |
Name |
SKU |
Price |
Total |
| |
| |
|
SubTotal: |
4.99 |
| |
|
Tax Total: |
0.32 |
| |
|
Shipping: |
0.00 |
| |
|
Shipping Tax: |
0.00 |
| |
|
Total: |
5.31 |
|
| |
| Payment Method |
Account Name |
Account Number |
Expire Date |
| Visa |
John Smith |
4111111111111111 |
Apr-2006 |
|
| |
| |
Payment information captured for later processing.
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