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  1. |~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| 
  2. |                                                                            | 
  3. |                                              Account #                     | 
  4. |                                                                            | 
  5. |                                              Discount =                    | 
  6. |                                                                            | 
  7. |                                              Total YTD paid  $             | 
  8. |                                                                            | 
  9. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
  10.