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RECEIPT
Date
Mois
Table
First name
Last name
Email
Agent
Company
Email
*
Item 1
Item 1 - Description
Item 1 - Qty
Item 1 - Price CDF
Item 2
Item 2 - Description
Item 2 - Qty
Item 2 - Price CDF
Item 3
Item 3 - Description
Item 3 - Qty
Item 3 - Price CDF
Item 4
Item 4 - Description
Item 4 - Qty
Item 4 - Price CDF
Item 5
Item 5 - Description
Item 5 - Qty
Item 5 - Price CDF
Item 6
Item 6 - Description
Item 6 - Qty
Item 6 - Price CDF
Item 7
Item 7 - Description
Item 7 - Qty
Item 7 - Price CDF
Item 8
Item 8 - Qty
Item 8 - Description
Item 8 - Price CDF
Grand Total CDF
*
Grand Total USD
*
Mode of Payement
*
Status
*
Signature
*
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