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SCAN T R O N <br />BILL TO: <br />ATTN: MARIBEL CARMONA <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ <br />PO BOX 1988 M-24 <br />SANTA ANA CA 92701 <br />INVOICE <br />LOCATED AT: <br />INVOICE NUMBER: <br />7117952 <br />DATE: 27-MAR-20 <br />Page 1 of 1 <br />CUSTOMER NO: <br />200249792 <br />CREDIT <br />REF NO: <br />TAX LID NO: 95-2767912 <br />ATTN: MARIBEL CARMONA, 5TH FL <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701 <br />Reference Num:SAS ORDER ENTRY 1471935 <br />PURCHASE INFORMATION <br />SHIPPING INFORMATION <br />PAYMENT INFORMATION <br />PURCHASE ORDER: <br />TERMS: NET 30 <br />LTR-PHAM <br />SHIP DATE: 27-MAR-20 <br />DUE DATE: 26-APR-20 <br />AGREEMENT NUMBER: <br />SALES REP: <br />CARRIER: <br />CONTACT: Jay Nanda <br />(800) 228-3628 <br />ORDER SOURCE: <br />B/L NUMBER: <br />Fax (844) 364-3126 <br />ScantronAR@HarlandClarke.com <br />T <br />DESCRIPTION <br />U/M <br />CITY <br />A <br />UNIT PRICE <br />EXTENDED PRICE <br />X <br />DESC JOB 4-20361801 FIRM F1452-FD 002 <br />EACH <br />0 <br />N <br />0.00 <br />0.00 <br />DESC Answer Sheet <br />EACH <br />0 <br />N <br />0.00 <br />0.00 <br />PVGPPG Scan Application <br />EACH <br />1 <br />Y <br />695.00 <br />695.00 <br />INVOICE SUMMARY: <br />TOTAL FOR ALL LINE ITEMS <br />695.00 <br />TOTAL FREIGHT <br />0.00 <br />6.00% STATE TAX <br />41.70 <br />2.00% CITY TAX <br />13.90 <br />1.25% COUNTY TAX <br />8.69 <br />Amounts not paid when due are subject to finance charges of 1.5% per month <br />or the highest rate permitted by law, whichever is less, compounded daily from <br />the due date until paid. <br />Please update remit to address if needed. <br />• My check/money order is enclosed: <br />o Check# <br />Charge to my Credit Card <br />o Visa MasterCard _Amex <br />o Card # Expiry Date_I <br />o Name of Card Holder <br />o Billing Address <br />o Signature <br />SUBTOTAL <br />TAX <br />TOTAL <br />695.00 <br />64.29 <br />(USA) <br />759.29 <br />Please Remit to: <br />SCANTRON CORPORATION <br />P O Box 93038 <br />Chicago, IL 60673 <br />CUSTOMER COPY <br />