Receipt from University of Alberta, Augustana Campus Online Payment

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https://payment.augustana.ualberta.ca/
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Card information
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Cardholder name: GERMAN GONZALEZ
Card number (First 4, Last 4): 4222***5951
Card brand/type: Visa

Transaction information
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Transaction date: 2017-03-04 09:55
Transaction type: purchase
Response message: APPROVED * =

Order/Response codes
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Order ID: mhp17062115447p27
Authorization code: 908838
Response code: 027
ISO code: 01
Reference number: 662232760014510040

Purchase Item Description & Amount

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Total (Canadian dollars): $420.00

Kodaly Symposium: Early Bird Registration x 1 @ $420.00 (plus $0.00 tax): $420.00

Additional information provided

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Name (as it appears on passport): CARLOS EDUARDO BASTO QUIJANO
Address: CALLE 8 #20-55
City: BUCARAMANGA
Province/State: SANTANDER
Postal code/Zip: 110011
Country: COLOMBIA

GST number: R108102831 RT001