#_________ Name _____________________________________________________________ Store # __________
Date ______________________________ Parent Signature _________________________________________
Item   Item  
Price   Price  
Sales Tax Rate   Sales Tax Rate  
Sales Tax   Sales Tax  
Total   Total  
Item   Item  
Price   Price  
Sales Tax Rate   Sales Tax Rate  
Sales Tax   Sales Tax  
Total   Total  
Item   Item  
Price   Price  
Sales Tax Rate   Sales Tax Rate  
Sales Tax   Sales Tax  
Total   Total