Assistive Technology Reutilization Program for Independent Living
SALES RECEIPT
DATE ITEM#
QUANTITY DESCRIPTION AMOUNT
PARAQUAD
5240 Oakland Avenue
St. Louis, MO 63110
Phone: (314) 289-4272
Fax: (314) 289-4201 TOTAL SALES
TTY: (314) 289-4252 RECEIVED CASH/ CHECK/ M.O.
www.paraquad.org BALANCE DUE
TERMS
CUSTOMER NAME Payment due ______ of every month
Make check payable to:
PARAQUAD
Assistive Technology Reutilization Program for Independent Living
SALES RECEIPT
DATE ITEM#
QUANTITY DESCRIPTION AMOUNT
PARAQUAD
5240 Oakland Avenue
St. Louis, MO 63110
Phone: (314) 289-4272
Fax: (314) 289-4201 TOTAL SALES
TTY: (314) 289-4252 RECEIVED CASH/ CHECK/ M.O.
www.paraquad.org BALANCE DUE
TERMS
CUSTOMER NAME Payment due ______ of every month
Make check payable to:
PARAQUAD