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\ \ 1 ~ ~ ~ ~ ~ ~ , INVOICE NUMBER <br /> ` EMPIRE - - <br /> CONCRETE <br /> ` CUTTING INC <br /> A <br /> 1484 CHEEK STREET SPRINGFIELD, OREGON 97477 <br /> . (54f) 746-8818 FAX: (541) 746-1149 CCB# 51754 <br /> - ~ ~ <br /> TO _ - - - - Day ~ Date <br /> j~- ~ P.O. No: <br /> Job No. f'r`~~'° <br /> ~ ~Y- <br /> • I; <br /> Job Address ~ - ~ 1~ `fi ~ ~ ~ ~ Operator - ~ <br /> QUANTITY D E S C R I P T f O N PRICE AMOUNT <br /> r Sr~. f ; ~r" l <br /> 2 r <br /> ~ f ~ <br /> r , <br /> ' r ~ ~ ~L t <br /> t <br /> 4 a <br /> c,< ti. <br /> ~ 2 zg R Da <br /> i' Z Z To: <br /> s ~ JOb <br /> EXTRA'S -CHARGE ORDERS -STAND BY TIME SIGNATURE ~tr <br /> 10 <br /> 11 ~ ifs ~ <br /> 12 $~It8hJf8 0~: <br /> , : ~ <br /> We do not assume responsibility for dai'mage caus$~ by~~Utting burred ; ~ ' ~ <br /> pipe, conduit, voids, steel beams, water damage, percussion damage, ~ _ _ <br /> or asbestos abatement. ~ <br /> <br /> The undersigned hereby understands and agrees to Empire • • • • ' ' ' ' <br /> Concrete Cutting credit conditions as follows: " ' ~ ' ~ ~ ' • ' <br /> t. Bills due and payable 10th of month following date of purchase, . • . - . • . - <br /> 2. Past due bills charge at 2% interest per month. <br /> 3. Should ECC institute collection on this account, I will pay reasonable attorney <br /> fees and costs incurred in the pursuit of collection, including court costs. <br /> SIGNATURE <br /> <br />