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- F & M Towing & Auto Salvage, Inc. <br /> 3001 Main Street W 5 ~ <br /> Springfield, Oregon 97478 <br /> Phone X541) 746-561 S • Toll free 1-800-386-5b 15 <br /> 2d-HOUR TOWING ~~77 ~~~~yy <br /> MAKE t._~ YEAR.G-~_LIC. NO. <br /> BODY TYPE ~ ~ r STATE D / REG. NO. <br /> DESCRIPTION OF CHARGE ~ AMOUNT <br /> TOWED ~ <br /> FROM ,,..C <br /> TOWED <br /> STORAGE L.~ V <br /> AT <br /> RETOW <br /> T4 <br /> FUSEES <br /> OUTSIDE LABOR <br /> & RECOYERY <br /> DOLLIE <br /> AUTHORIZED TOW <br /> TOTAL ~ ~~s'f(~ <br /> The undcrsigncd agrcc. ~omtly and severally, ra pay r & M Towing & Auto Sal- CHARGES <br /> vagc, tne. within thuly 130) days From date of service, thr: arnrwnt set Cosh above <br /> for the urviccs described above Interest at the rate of 10' <br /> ~ per annum from date <br /> shall atso be paid The undersigned further agrcc and understand that F & M Towrng & AWO Salvage, Inc. may forward this account ut thnr <br /> attomcys or agent for collection upon the expiration of :.aid 30 days and in that cvcm the undcrsigncd, jomdy and severally. agrcc to pay a Imc <br /> payment service charge of ES 00, plus a reasonable attomcys fee to be Fixed by the coon incase suite or action is inntitutcd to collect the whole <br /> a' part of wch amount, plus attorney ~r fees necccssitated by appeals from a decision of a lawn mwt <br /> INFO <br /> ADDRESS <br /> The undcrsigncd agrcc, that f & M Towing & Aut (vagc. Inc <br /> shall not be held liable fur damage to the above described vehicle INSU <br /> ur equipment, occwYing during the removal or tranxprnt caused by <br /> ihcposinon,locationrn~condnianofthcvchrclc. F&MTowmg& SIGNATURE <br /> Auto Salvage. Inc. will be held harmless by the undcrsigncd from <br /> all claims of any nature arising from the removal of the vehicle INSURANCE CO. <br /> fi~otn any location, public or private. <br /> POLICY 8 <br /> X AGENT ~ <br /> 1 have authorized F & M TOWING & AUTO SALVAGE INC. to tow my car and <br /> 1 hereby authorized my Insurance Company to make payment to this towing agency on <br /> Amount <br /> my behalf. <br /> Signature Dale <br /> OWNER'S <br /> NAME <br /> <br /> ADDRESS <br /> <br />