#### Form Wizard

| Item | Quantity | Price | Subtotal
--- | --- | --- | --- | ---
| Vincent Chase VC 5158/P Size: Medium | 1 | $180.00 | $180.00
| Vincent Chase VC 5168 Size: Medium | 4 | $200.00 | $800.00
| Vincent Chase VC 5168 Size: Medium | 2 | $180.00 | $360.00

#### Summary

Subtotal: $1,340.00

Shipping: $100.00

Discount: $60

Grand Total: $1380.00

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Last Name
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Total Payment Amount: $1380.00

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