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OUT5IDE:BQR <br />'&~-RECOVERY- , <br />~,, <br />~AUTHQR#~EDTQW <br />" -. - <br />,~ ~.~-. <br />T~TaL :.~ <br />Tlic~:undcrrigncd agree, jointly and severally, to pay F & M Towing & Auto 5a#- CHARGES ~ ~{. . <br />~• ,.:va~c:tiic~+vtf i~,.thilly (30~ days from date of service, the amount set fotlh above <br />`~-"~' •' far.thc ticry~cc` dc~critresi above, Intcrctit of thc~ratc of #Op~~ per annum from date . <br />shall alyo:>t;;j~id. ~'he undersigned further agree and understand that F & M Towing & Auto Sa#vage, Inc. may fo~ward~this account to their _ <br />attomcys; or"a~cn~ For collection upap the expiration of said 3Q days and in that event the undersigned, ,jointly and sevci~lly, aga~cc to pay a late <br />~ayi>icn~~se~vic~_charge of SS.04, plus a reasonable attorney's fcc to be fixod by the court incase suite ar action is instituted to collect the whole <br />or parr o4` ziicii amount, Pius attorney's fees nccccssitatcd by appeals from a decision of a Iowcr court. , <br />sr~NEO .. <br />BY X .. <br />. . ,~~-DDRESS~~~ ~ - <br />Thc~i+~tder~igicd:a~rcc, that F & M Vowing & Auta Salvage, Inc. <br />shall dot be Itic#d liable fpr damage to the above d~cribcd vchiclc INSURED'S NAME <br />or cquipincnt'occurring during the removal or transport caused by <br />- the. position, location ar condition of the vchiclc. F & M Towing & SIGNATURE <br />Auto Salvage, Inc. will 6c hefd harmless by the undersigned from ~ '. <br />ali c#aimti of any riaturc arising from the removal of the vchiclc INSURANCE CO. <br />tram any location, public or private, ,; <br />POLICY # <br />X _ . i AGENT # <br />I have authorized F & M ~aWING ~ Alf~~ SALVAGE INC. to taw my car and •~ <br />to <br />I hereby authorized my Insurance Company to make payment to this towing agency on <br />Amount ~ <br />my behalf: <br />Signatdre Date <br />_.~ <br />OwNER~s ~- <br />r <br />~~ <br />~ } <br />ADDRESS <br />_..,. _ ......-_~.__._._..~__._M.~._.._.._._...._.___.._....__.~_....._....__...,_._... ~__~~.__.._..~__ ....---....._ ................. _ ....... _~ <br />