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PO# ALLIANT ENERGY FAMILY&RETIREE EMP PAYS 100% . REQ# Bill-To: 05288743 . EMPLOYEE# MADISON WI 53718 . . Exp (mm/yy) . 16 digit SCCID (xxxx-xxxx-xxxx-xxxx) . *Amount . Do NOT enter an actual credit card number . Company * Amounts may be increased by any applicable taxes. * Signature required for Emp Credit Card charges Lens Style E E E E E E 17.50 27.50 27.50 114.00 47.50 58.50 E 68.50 E 88.50 E E 98.50 122.50 E 172.50 Who R CoPay Amt Pays E Q Polycarbonate Tr.

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