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F & M To & Anto Sale I ; . <br /> k ~g age, nc. <br /> 3001 Main Street `A' <br /> <br /> ' ~ Springfield, Oregon 97478 Mr <br /> Phone (541) 746-5615 • Toll Free 1-800-386-SG 15 - <br /> 24-HOUR TOWING .DATE ~ 1 ~a <br /> . . <br /> MAKE !`r / S '1 ~i ~ ~ YEAR f LIC. NO. / r ~ ~ ~ _ + <br /> a <br /> <br /> ' i' BODY TYPE - <br /> STATE ~ REG, NO, <br /> j. DESCRIPTION OF CHARGE ~ ~S~ 02 <br /> ~ AMOUNT. <br /> [ TOWED <br /> ~..G <br /> e. FROM ~ / 1' O ~ J C'-~ <br /> I O /1~ <br /> <br /> i <br /> ~ TOWED ~j qZ <br /> <br /> ' STORAGE <br /> AT <br /> r <br /> ` RETOW . <br /> TO ~ ' <br /> FUSEES . <br /> <br /> I' OUTSIDE LABOR <br /> & RECOVERY ~ <br /> <br /> i ' <br /> DOLLIE ~ " ~ <br /> 1 <br /> , <br /> 'AUTHORIZED TOW <br /> TOTAL ~~j ' ' 1\'!~, <br /> The undersigned agree, jointly and sevwally, to pey F & M Towing & Auto Sal- ~ CHARGES 7 - ~ <br /> vagc, Inc. within Ihiny (30) days from daze of ticrvix, the amount set forth above ~ ~ n <br /> ' ~ fw the kiwiccx dctcribed above. Imercst a! the tart of 10°/, per annum from date <br /> shall also be paid. The undersigned further agnx and undenyand that F & M Towing & Auto Salvage, Inc. may forward this accoum tp their <br /> anomcys w agrnt fw cdleaion upon the expiration of said 30 days and in that event the undersigned, jointly and severally. agree to pays late ~ v <br /> " payment service charge of S , p a tunable attorney + fa fixed by the eWrt in east suite waaion ix ina7imtcd to collet the whole ® _ ^ <br /> wpan of such amount, ux aztomcy ~ f .vita a als decision of a tower coon. ~ ((~(`~,J <br /> SIGNEp V <br /> BY X <br /> ADDRESS ~ ' ~ _ <br /> The undcrsigxd agree, [hat F & M Towing & Auto Salvage. Ix. , <br /> shall not beheld liable fw damage to the about dct'cribcd velliclc INSURER'S NAME ~ - <br /> or equipmcm,oxurtingduringthcrcmovalwtranspatcauscdby <br /> ~.thcpatition, Iacationweonditionofthevchiclc. F&MTowing& SIGNATURE <br /> ,Auto Salvage, Ix. will be hcM harmless by the undersigned from-` <br /> " ~ all claims of any nature arising from the removal of the vchidc ~ INSURANCE CO. ~ ~ ~ • <br /> from any location, public w private. <br /> POt.ICY # <br /> X AGENT# ~ ' <br /> I have authorized f & M TOWING`& AUTO SALVAGE INC. to tow rtty car and " . <br /> I hereb authorized m Insurance Com y paym <br /> Y Y pan to make ent to this towing agency on ; . <br /> my beholF. "'"O°"' <br /> Signature Date <br /> :OWNER'S ~ r <br /> NAME t ~ ~ ~ . ~ C,~ s~ <br /> ADDRESS P~1. r. ~ . _ <br /> <br />