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~ ~ l Page : 2 <br /> T <br /> L <br /> E <br /> B <br /> N <br /> u <br /> ALS <br /> NT <br /> ~ . sir ~`i''?iii<ii:ii??:i :>'i"':ii. <br /> ND <br /> 2 <br /> W. <br /> 21 <br /> <::>:>!::<:~!C~ SQL:;><4 <br /> EUGENE, OR 97402 ~T1:,'~,~k, G,A. ~pg4 <br /> . ~ 541-484-2511 <br /> v , <br /> RENTAL RETURN <br /> sir <br /> r~ <br /> ~{~s~a :<>:::>::::::.:<.:.:::: ::.::~}.7':~., T.. ~y pry;/ :.i:.i~a .i::: i i:: <br /> ~ ~~rk~.~iv..:::. .~::e:a.,i........:~.~.~:M7:,~7..~.~..........:.:.:::::::::::::::: <br /> :....:.~:::::::::::::::::.:.f..............::: k::.. ; . <br /> T,~~.++.~~y.y :::.mo~ww::..... .:.::..~.~:1::. :,:~:y: ~ ..A...::::::::::6:::::::::........ <br /> i5i: i:i:. °5f'i'~`v~i? 2r>i+i.. ';i ':':i'Js:~;.: ii <br /> ~i:ii;i:ijii~.y.~1::.:i;.:i; ::::`i..:.. i.:%~i~<;+;: <br /> ~:.:~::.i::•::~,': is is i:.:::~:.iii:: i::::.:.:::•:: i::::::: :::.:i:.::. .:::iii:.::J'^:.::C::•:::':::.:.:::.::.:is'•:''i:.i::::':.::.:i yYf~ii: li-~::'::::.. <br /> .::::.::::;:.:.:':::..~::"::::isii::i:":'.::,:yr::"::is~:~::iJi:::::::::i:::::•li.l:•:~i:~'~:::i ~ . <br /> ~~b TaC~C ~ l~~R~QT ~~~'~J~ ~",IC' , ~G <br /> ~ut~~~~., QR 6836'~09p ; <br /> # <br /> ~U~3~, ~7~01 . ec~' By:.', ~x~~.., GGf~' <br /> i..:...::::.: , <br /> ~M!± iii.:: . <br /> >:<:::::<:::>::>;s::»>::>;: <r »s::>;::::::><:::«:::;>::::»:::<::t?itt:i:'<' :;;:::>::.»>::>::l3iss::»>::::»::>::':>::ia<s>::>:::z:>:z 8i?s <::>i:<:::»::><:::::>:::»:.>?:::>::isS?iS's;'C?:?i::>P?i <br />???Bi:'i.'E::::>::'<: <:<;?`s:i: r:;:,;:»:.i:i<:::>;::y?i`;: »>::a:s::»::»'i;i>r::>: i>::a:is:%:>::>:<:;i>iiiii::;: <br /> ;;...:..i <br /> i::.. <br /> Sub-total: 300.50 <br /> Total: 300.50 <br /> ~ f .;~,00.5U= <br /> <br /> . Balance .paid _ <br /> FINAL BILL: 5/19/04 08:30 AM THRU 5/19/04 05:00 PM. ~g~ <br /> , . <br /> Customer must call to release equipment end Is responsible for released equipment until it is picked up. <br /> . I have had the opportunity to read the terms and conditions on both aides of this agreement, I have received and understand the safety instructions on the operation of the equipment <br />I am renting. I <br /> have received a complete copy of this agreement and agree to the terms and canditlona on both sides. (Carefully read the terms and conditions on the reverse side of this page.) <br /> 3. Failure to return rental property or equipment upon expiration of the rental period and failure to pay all amounts due (including cost for damage to the property or equipment) <br />are prima facie evidence of <br /> Irrtem to defraud, punishable in accordance with section 812.155, Florida Statutes. <br /> Rental Protection Plan (LDWI YES NO Customer Initials. Code of safe practices for all scaffold rentals issued. <br /> 4. If paid by credit card: "I agree to pay <br /> above as <br /> per this sale contract according to the card issuer agreement" <br /> CUSTOMER SIGNATURE DATE NAME PRINTED DELIVERED BY DATE <br /> <br />