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Receipt

Account / Payable to

CH44 3199 9123 0008 8901 2
Thomas LeClaire
Rue examplaire 22a
1000 Lausanne

Reference

12 34567 89012 34567 89012 34567

Payable by (name/address)

Currency

EUR

Amount

Acceptance point

Payment part

Currency

EUR

Amount

Account / Payable to

CH44 3199 9123 0008 8901 2
Thomas LeClaire
Rue examplaire 22a
1000 Lausanne

Reference

12 34567 89012 34567 89012 34567

Payable by (name/address)