Online Payment Receipt

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Receipt number 1002515126
Date 19 Jul 2012 17:18
Reference number 12345678
Payment amount $32.95 AUD
Surcharge amount $1.33 AUD
Total payment amount $34.28 AUD
Card holder name John Smith
Credit card number 456471xxxxxxx004
Expiry date (mm/yyyy) 02 / 2019
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