8880 S DELAWARE AVENUE TULSA, OK 74137

STORE MANAGER LIZ ALLEN 918-2993028

3915 00002 55554 01/23/15 05:35 PM

CASHIER MICHELLE - MES0225

077924006258 GENESIS GRL 213.03

WEBER GENESIS S310 LP

SUBTOTAL 213.03

SALES TAX 18.14

TOTAL $231.17

XXXXXXXXXXXXXXXX VISA 231.17

AUTH CODE 08127D/1025223 TA

3915 02 55554 01/23/2015 2247

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POLICY ID DAYS POLICY EXPIRES ON

A 1 90 04/23/2015

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