EFTA00311345.pdf

Busy Body Gyms to Go Credit Card Authorization Form Lisloiller ItTrium,ujim Customer Name: JEFFREY EPSTEIN (Please Print) Type of Card (please check one): ri American Express O MasterCard O Visa O Discover O Debit Billing Address: 9 EAST 71" STREET NY NY Billing Zip Code: 10021 Credit Card Number: J Expiration Date: 8/16 CVV Number (the 3 or 4 digit code after credit card number on the front/back of card, please see below): 9047 4 DIGIT VERIFICATION NUMBER 3 DIGIT VERIFICATION HUMBER ACK Of CARD RONT OF CARO Amount of Credit Card Charge: 2586.37 Customer \lino\ 0! I authorize and agree to pay the above amount per the credit card issuer agreement. • 6,41-0-7 12/30/14 Customer Signature Date PLEASE COMPLETE AND FAX BACK TO: 964781-1575 / ATTN: Melissa Yergin For Busy Body Use Only: Invoice Number: 79 -6400 Date.12 15 14 EFTA00311345 BUSYBODY GYMS-TO-GO 1/021 SOUTHERN BLVD # 150 Invoice #: 79- 6400 ROYAL PALM BEACH, FL 33411 Sale Date: 12/15/14 SP: CARLOS VAZQUEZ CUSTOMER JEFFREY EPSTEIN SHIP TO 756178 358 ELBRILLA WAY PALM BEACH, FL 33480 TELEPHONE (HOME) (WORK) DELIVERY INSTRUCTIM INSPIRE FT1 GYM: INSTALL WT STK LABELS PRECOR AMT 885 P80: CHECK PROGRAMMING DOP: 11/22/14 79-6276 CALL 1/2 HR AHEAD - JANUSZ 561-818-8361 OTY SKU DESCRIPTION UNIT AMOUNT 1 0610146 INSPIRE FT2 NEW FUNCTIONAL TRAINER FT WI 3,595.00 3,595.00 1 0710203 INSPIRE SCS-WB FID BENCH 349.99 349.99 1 0710204 INSPIRE SCS-LE LEG EXT ATTACHMENT 99.99 99.99 1 0710249 INSPIRE FT2LK CONVERSION KIT FOR SCS BEN 39.99 39.99 SUB-TOTAL: 4,084.97 TAX: 266.10 DELIVERY CHARGE: 350.00 TOTAL: 4,701.07 PAYMENTS/ADJUSTMENTS: BALANCE DUE: 4,701.07 ALL VITAMINS AND SUPPLEMENTS ARE NON-RETURNABLE - ALL SPECIAL ORDERS ARE FINAL, NO REFUNDS - ALL OUT OF BOX AND FLOOR MODEL SALES ARE FINAL FULL REFUND WITHIN ONE WEEK OF DELIVERY MINUS DELIVERY FEE - A 15% RESTOCKING FEE APPLIES IF RETURNED AFTER ONE WEEK - NO RETURNS AFTER 14 DAYS ALLOWED, UNLESS APPROVED BY MGMT. - PRODUCT MAY BE RETURNED WITHIN 30 DAYS TO UPGRADE ONLY - FOR SERVICE CALL 954-781-1787 EXT. 212 EFTA00311346 BUSYBODY GYMS-TO-GO CREDIT INVOICE #..: 79- 6399 11021 SOUTHERN BLVD # 150 PAGE # • 1 ROYAL PALM BEACH, FL 33411 DATE • 12/15/14 561-753-4740 SALESPERSON: CARLOS VAZQUEZ CUSTOMER JEFFREY EPSTEIN 756178 358 ELBRILLA WAY PALM BEACH, FL 33480 HOME - WORK - OTY SKU # DESCRIPTION PRICE EXT.PWR 0440080 PRECOR AMT 885 P80 PHRCA8853660EN OPEN STRIDE 8,995.00- 1 0610119 INSPIRE FT1 W/BENCH FUNTIONAL TRAINER 1,995.00- 1,995.00- TERM OF SALE.: AP SUB TOTAL 1,995.00- RETURN DATE..: UNKNOWN SALES TAX 119.70- TOTAL AMOUNT 2,114.70- - ALL VITAMINS AND SUPPLEMENTS ARE NON-RETURNABLE - ALL SPECIAL ORDERS ARE FINAL, NO REFUNDS - ALL OUT OF BOX AND FLOOR MODEL SALES ARE FINAL - FULL REFUND WITHIN ONE WEEK OP DELIVERY MINUS DELIVERY FEE - A 15% RESTOCKING FEE APPLIES IF RETURNED AFTER ONE WEEK - NO RETURNS AFTER 14 DAYS ALLOWED, UNLESS APPROVED BY MGMT. - PRODUCT MAY BE RETURNED WITHIN 30 DAYS TO UPGRADE ONLY - FOR SERVICE CALL 954-781-1787 EXT. 212 EFTA00311347