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UNBELT ~ Page : 1 <br /> . _ _ , <br /> ' a.-~~ RENTALS <br /> -~.;r~ <br /> 2110 W . 2ND ~TJI~BELT RENTALS ING ; <br /> E'O BEaX 4 0 9 21 I <br /> EUGENE, OR 97402 A'I'LAN'Z'AF'_G.2~..;?34384 9~~.~. <br /> 541-484-2511 <br /> Jqb ' S 1. to ; <br /> RENTAL RETURN <br /> FERRY ST! BRIDW'rE III IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> EWEB PARKING LOT <br /> 4TH' ST , <br /> EUGENE, OR 97401 Znvo~ee # 1188469 Qa2 <br /> _C#: 541-683-6,Q90 J#: 541-953-OE~94 Invozce date 1Ct/08/03 <br /> Dade aut...'. 10/03/03 8:34 AM:': <br /> Date in'..... 14/03/03 3:00 PNf <br /> Customer: ©R 6836090 J"+~b Loc'..... EWEB PARKING LOT, EUG <br /> ;.QHEC, CONSULTING Job No.',...:. <br /> 92'.0 COUNTRY.. CLUB RD STE 10 QB P . C)'. # < , <br /> ~ EU'GENE, C~K 97401 Ordered By.. GQRDC7N, <br /> . , <br /> N$T`. DUE'; UPON RECEIPT ; <br /> EQUIPM~yNT # NFan T?a~r Week' 4 Week Ainotu~t' , <br /> 1 60' MANLIFT 2WD DF 260.00 260.00 800.00 1900.00 260.00 <br /> IB10475 Make: JLG Model: 600S Ser 300043037 <br /> HR OUT: 2289.00 HR IN: 2294.00 HOURS: 5.00 <br /> Billed from 10/03j03 thru 10/03/03 <br /> SALES ITEMS: <br /> qty Item number Unit Price <br /> '1 ENVIRONMENTAL EA 2.500 2.50 <br /> ENVIRONMENTAL <br /> 1 RENTAL PROTECTION PLAN EA 31.20 <br /> DELIVERY CHARGE 25.00 <br /> PICKUP CHARGE 25.00 <br /> <br /> AYMENT HISTORY <br /> DATE TYPE REF # AUTH # TRANS TYPE AMOUNT APPLIED <br /> 9/30 03 Pay On Return <br /> 0/08/03 MASTERCD PC323 ****85 005918 CHARGED 343.70 <br /> Sub-total: 343.70 <br /> CONTINUED <br /> 1. Customer must call to release equipment and is responsible for released equipment until it is picked up. <br /> 2. I have had the opportunity to read the terms and conditions on both sides of this agreement, I have received and understand the safety instructions on the operation of the equipment <br />I am renting. I <br /> the r8ceived a complete copy of this agreement and agree to the terms and conditions on both sides. (Carefully read the terms and conditions on the reverse side of this page.) <br /> ilure'to return rental property or equipment upon expiration ofi the rental period and failure to pay all amounts due )including cost for damage to the property or equipment) are <br />prima facie evidence of <br /> tent to defraud, punishable in accordance with section 812.155, Florida Statutes. <br /> Rental protection Plan IIDW) YES _ NO _ Customer Initials. Code of safe practices for all scaffold rentals issued. <br /> X <br /> CUSTOMER SIGNATURE DATE NAME PRINTED DELIVERED BY DATE <br /> W W W,SunbNtllm4M.oon <br /> <br />