Please pay from this invoice.

INVOICE

NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION

Invoice Enclosed

Print address changes on the reverse side.Make Checks Payable to

Account xxxx xxxx xxxx 4911

Amount Due $253.24Transaction Date 01/27/14

Payment Due Date 03/19/14

Invoice #: 2055522

Page 1 of 4 This Account is Issued by Citibank, N.A. 27

RED CLIFFS REGIONAL REHA1745 E 280 NST GEORGE, UT 84790-2400

Customer # Purchased By Authorized By Purchase Order/Job Name Customer Agreement #

Store / Register #: 4412, WASHINGTON CITY

SHIP TO:

Please detach and return lower portion with your payment to insure proper credit. Retain upper portion for your records.

Your Account Number is xxxx xxxx xxxx 4911

Amount Due

Due Date

Invoice Number

$253.24March 19, 2014

2055522

HOME DEPOT CREDIT SERVICESDEPT. xx - xxxxxx4911PO BOX 183175COLUMBUS OH 43218-3175

PRODUCT SKU # QUANTITY UNIT UNIT PRICE TOTAL PRICEWOOLITE CLNR 00005818510000400011 1.0000 EA $4.97 $4.97RE1000 RTR 00009020840000900018 1.0000 EA $59.98 $59.98RE1000 RTR 00009020840000900018 1.0000 EA $59.98 $59.98OB B2G1 FREE 00006958110000400025 1.0000 EA $1.53 $1.53RE1000 RTR 00009020840000900018 1.0000 EA $59.98 $59.98CHARMIN ULTR 00005360350000400022 1.0000 EA $12.97 $12.97DEBRIS PAN 00004728860000400005 1.0000 EA $16.99 $16.99CHARMIN ULTR 00005360350000400022 1.0000 EA $12.97 $12.97QW BUCKET 10000178420000400019 1.0000 EA $8.97 $8.97

SUBTOTAL $238.34TAX $14.90SHIPPING $0.00TOTAL $253.24

Please pay from this invoice.

Change of AddressPlease print address changes in blue or black ink.

Page 2 of 4

T04071-9196-1400-0002--0------P--0--0-0-0------- --- -0

INVOICE

Page 3 of 4 1-800-685-6691 myhomedepotaccount.com

Invoice #: 2055522 cont.

Account xxxx xxxx xxxx 4911

Transaction Date 01/27/14

Payment Due Date 03/19/14

Remit payment and make checks payable to:HOME DEPOT CREDIT SERVICESDEPT. xx - xxxxxx4911PO BOX 183175COLUMBUS OH 43218-3175

Page 4 of 4 1-800-685-6691 myhomedepotaccount.com

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