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A <br /> F & M Towi & Auto <br /> ng Salvage, Ine. <br /> 3001 Main Street W 5 ~ ~ l <br /> Springfield, Oregon 97478 <br /> Phone (541 ~ 746-5615 • Toll Free 1-800-386-5615 <br /> 24-HOUR TOWING <br /> v / DATE 2p(~`" J <br /> MAKE / ' !1` YEAR ~ LIC. NO ~ ~,~G~~!'-J/ <br /> BODY TYPE `7 ~C/ a--- STATE ~ <br /> REG. NO. <br /> DESCRIPTION OF CHARGE ~ S AMOUNT <br /> TOWED <br /> FROM ..t 1 ? ? l~-4 ~ ~ - C <br /> TOWED o ? <br /> TO ~ r ~ f ~ <br /> STORAGE <br /> AT <br /> RETOW <br /> TO <br /> FUSEES <br /> OUTSIDE LABOR <br /> & RECOVERY C ' Y ~ ~~'t., ~ S, C_- G-~' <br /> DOLLIE <br /> AUTHORIZED TOW <br /> TOTAL <br /> The undttsigncd agree. jointly and severally, to pay F & M Towing & Auto Sal- CHARGES ~ ~j' <br /> vagc. Inc. within thmy (J01 days from date of service, the arnoum ut forth above <br /> f'or the services described above. Interest at the rate n( 10' ~ per annum from date <br /> shall aku be paid. The undersigned further agrcc and undcntand that F & M Towing & Amo Salvage, Inc. may forward thin account m their <br /> auomcys or agcm for collection upon the expiration o(said JO days and in that cvcm the undcrsigncd, jointly and severally, agrcc to pay a late <br /> payment service charge of 55.00. plus a reasonable anomcy's fee to be fixed by the covet incase suite or action is instituted to collect the whole <br /> pan of such amoun lux auomcy'x fees necccssitated by appeals from a decision of a lower covet. <br /> ~.rVED -.w..~...__ <br /> ADDRESS rr_ <br /> The undcrsigncd agrcc, that F & M Towing & Aum Salvage. Inc <br /> shall not be held hahlc for damage to the above dcscnbcd vehicle INSURED'S NAME <br /> or equipment, occurring during the removal or transport caused by <br /> the position. location or condition of the vehicle. F&MTowing& SIGNATURE <br /> Auto Salvage, Inc. will be held harmless by the undcrsigncd from , <br /> all claims of any nature arising h~om the removal of the vehicle INSURANCE CO. <br /> from any location, public or private <br /> POLICY ~F <br /> X AGENT ~ <br /> I hove authorized F 8 M TOWING 8 AUTO SALVAGE INC. to tow my car and <br /> I hereb authorized m Insurance Com an to make a ment to <br /> Y Y P Y P Y to this lowing agency on <br /> my behalf Amount <br /> Signature Dale <br /> OWNER'S / <br /> NAME L- ~ ~ ! Cs r~,~ L 1 ~"/..8 <br /> <br /> ADDRESS r <br /> <br />