New Search
r ~ <br /> F & M Towing & Auto Salvage, Inc. <br /> 3001 Main Street W ta` 6 <br /> Springfield, Oregon 97478 <br /> Phone (541) 746-5615 • Toll Free 1-800-386-5615 <br /> 24-HOUR TOWING <br /> DATE ~ / 02' ~ _ 20 <br /> MAKE ~I ~ F~ YEAR ~ LIC. NO.~,~IC 7 1 i <br /> t C>, ~ N <br /> BODY TYPE~~r~~ ~ STATE r~l REG. NO. <br /> DESCRIPTION OF CHARGE S AMOUNT <br /> <br /> TOWED _y f" -.r. G C. <br /> FROM L ,.q !J J ~ <br /> <br /> TOWED f, ~ 1 <br /> <br /> TO <br /> STORAGE <br /> AT <br /> RETOW <br /> <br /> TO <br /> <br /> OUTSIDE LABOR G,I <br /> <br /> a`te RECOVERY <br /> DOLLIE <br /> <br /> AUTHORIZED TOW <br /> TOTAL _ <br /> The undersigned agwc, joimly and severally, to pay F & M Towing & Amo Sal- CHARGES ~ ~ ~ G <br /> vage, Inc. within thuty (J01 days from date of scivtce, the amoum set (ath above <br /> for the services described above. Inicrest at the rate of 10' ~ per annum from date <br /> .hall also be paid. The undersigned fwther agrcc and unda~land that F & M Towing & Awo Salvage. Inc. may forward this account to their <br /> auomcys or agent for collection upon the expiration of said 30 days and in That evem the undersigned, jointly and severally, agrcc io pay a laic <br /> ~ayment service char ~c of 55.00, plus a reasonable anomcy5 fee to be fixed by the cowl in case swte oracuon is instituted io collect the whole <br /> oan of such ounL s attomcy's fees neccessitated by appeals from a decision of a lower cowl. <br /> BY X <br /> <br /> ADDRESS <br /> The undersigned agrcc, that F & M Towing & Auto Salvage. Inc <br /> shall not be held liable for damage m the above described vehicle INSURED'S NAME <br /> or equipment. occun-ing during the removal or transpon caused by <br /> the position, locauon or condmon of the vehicle. F&MTowing& SIGNATURE <br /> Auto Salvage. Inc. wdl be held harmless by the undersigned finm <br /> all claims of any namrc arising from the removal of the vehicle INSURANCE CO. <br /> from any location, public or private <br /> POLICY S <br /> X AGENT 7f <br /> I have authorized f & M TOWING 8 AUTO SALVAGE INC. to low my car and <br /> ate <br /> I hereby authorized my Insurance Company to make payment to this towing agency on <br /> Amount <br /> my behalf. <br /> Signature Dale <br /> <br /> OWNER'S <br /> NAME <br /> <br /> ADDRESS <br /> <br />