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~ ~ ~ ~ ~ ~ F ` .'may ~ ~~~~i <br /> { ~ i <br /> ~ E <br /> F&~T ' <br /> o & Auto S v <br /> al In <br /> ~ ~ c~ <br /> i~, <br /> 3041 Main Sheet ~ E <br /> Sprtngfteld, Qregon 97478 . <br /> Phone (54 ~ j 74fr5~ ~ 5 ~ Tall free 1-$00-38b-5615 <br /> E <br /> 24-HOUR TOWING <br /> DATE • E <br /> l 20 <br /> k MAKE d` <br /> YEAR LIC. No. <br /> E <br /> j <br /> BODY TYPE STATE ' <br /> REG. M0. <br /> <br /> F <br /> - DESCRIPTION of CHARGE ~ AMOUNT <br /> TOWED ~ ~ ~ i <br /> FRAM ~ <br /> TOWED <br /> TO f <br /> 5TQRAGE <br /> AT <br /> E <br /> RETOw <br /> TQ ; <br /> i <br /> . ~ <br /> FUSEES <br /> i <br /> ouTSIDE ~AeoR ~ ~ . <br /> & RECOVERY { <br /> DOLLIE <br /> ; <br /> AUTHORIZE©TOW ~ <br /> t <br /> f <br /> E <br /> TQTAL ~ <br /> Titc undersigned agree, jointly and uvcrally, to pay F & M'Towing & Auto Sa!- CHARGES p <br /> . vatic, rite. within thirty t30y days from date of ~crvicc, the amoum tiet forth above <br /> far the services dcsctibcd about. lntcrest at the t•atc of 10°/p per annum from date ~ <br /> rhali also be paid. The undersigned further agme and undc~xtand that F & M Towing & Auto Salvage, lnc. may forward thi` account to thci~~ <br /> attomcys or agent for collection upon the expiration of said 30 days and in that event the undc~signcd, jointly and scvci•ally, agrcc to pay a late ;E <br /> payment ;service charge of~5.U4, plur• a reasonable attomcy's fcc to be fixed by the coup in case suite oraction is instituted to collect the whore <br /> or trait otzuch amount, pluti attarncy :5 fees nccccssitatcd by appeals fmm a decision of a lower couEy. <br /> i <br /> SIGNED <br /> BY <br /> ADDRES5 <br /> The iindc~signcd agrcc, that F & M Towing & Auto Saivagc, lnc. <br /> shall not be herd liable fa• damage to the about deuribed vcl}iclc . IN5URED'S NAME <br /> or ccluipmcnt, occurring during the removal ar transpait catrscd by <br /> thcposition,locationorconditionofthcvchicic. F&MTowing& SIGNATURE ~ <br /> Auta Salvage, inc. wilt be herd harmless by the undersigned firm <br /> al! claims of any Rature arising from the removal of the vehicle INSURANCE Co. - ~ ~ . <br /> Pram any iocatian, public or private: <br /> POLICY # I <br /> i• <br /> X AGENT # <br /> i <br /> . I have authorized F lv~ T4W~NG 8~ AUT4 SALVAGE INC. to taw my car and <br /> I hereby authorized my Inst~ratue Company to make payment to this towing agency an <br /> my behalf. Amount <br /> 1~ <br /> Signature Date <br /> owNER~s <br /> NAME ~ <br /> r:. <br /> ADDRESS <br /> ~ , . 1 <br /> <br />