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~ <br /> <br /> r TCw1NG SERVICE, I~IIC. ..it's time to ex ect more from a Cowin coin an <br /> p 9 p Y <br /> t <br /> P.4. Box 24243 Eugene Spring~ieid Fax <br /> Eugene, 4R 914Q2 {54~ <br /> j 342-2386 (541)126-0222 ~54~~ 683-61n1 ~ <br /> } D to Gall # Start Time ~M Finish Time AM B~iiing Code' P.O. # l Case # <br /> Name <br /> Home Phone # .Work Phone # <br /> f ~ ~r <br /> Address..;, . ~ ~ <br /> , <br /> . <br /> , - <br /> ~ <br /> C~ ~ State Z-!~ . ~ Odometer ~ Driver ! Re istered Owner ~ <br /> i I <br /> 7, ti <br /> 1 Year Make 1 Model Color <br /> E~' ~ s; <br /> t- <br /> Vin # S#a#e Plate # <br /> ~ <br /> t~ <br /> ~.ocation of Vehicle <br /> Tow to Destinatilon <br /> I <br /> r: <br /> .Insurance Policy # Agent's Name <br /> I authorize to pay Dannevik's Towing for the service provided on <br /> r. I <br /> Reason forTaw Miiea a Labor Time Extra Person Kee <br /> s.. <br /> ' ? Accident <br /> t . <br /> ? Abandoned Be . ~ ~ Finish <br /> g Finish Y <br /> , <br /> ? Tow Zone <br /> Jam. <br /> ' : ~ ~ . <br /> ? Stolen Finish r StartStart ~ ~N~; <br /> i ~ Arrest rwet'# <br /> ~ ? Impounded _ Start j ~ Total, ~ ' Total, . r <br /> ~l:Unknouvn ~ - <br /> E ui .l Services Towinq,Charges~ PersonalsTaken g Date. <br /> Recovery T `~ti w~ - - - <br /> i. <br /> inspected bX Date <br /> Labor Miles y,1 ~x ~ <br /> ~ ~ <br /> Clean Up Dollies ~ ~ - ~ Released To B <br /> ~ <br /> Lock Out Drive Line. <br /> Me#had of Pa ment <br /> - _ <br /> Y_., - Cash <br /> Gas Delivery Jumpstart <br /> ~ Check # <br /> f. <br /> 2 Gal. Gas Re-Tow <br /> Gk Gdarantee # <br /> Flat Tire , r: R Miles ~ ; <br /> • T r <br /> . <br /> tt <br /> , . CC~# <br /> k: <br /> ` o- ~ <br /> Stand By ~ Storage _ <br /> , Exp. <br /> ` Dispatch Fee ~ .Gate Fee <br /> ODL # Exp. <br /> Flares 2nd Truck Authorized Si nature Date <br /> k , end IT IS UNDERSTOOD THAT IF FOR ANY REA50N - <br /> Outside Charges Truck. Miles THIS CLAIM IS REFUSED BY MY INSURANCE <br /> COMPANY IN PART OR IN FULL, I W1LL ASSURE <br /> Total Total RED, ONSIBILITY,FOR PAYM NT. <br /> , ~ <br /> ` Discou Grand Totat~ ~ <br /> indicate Remarks or Dama ~ ed Area s on back of Pink`Invoice.~ <br /> - , <br /> , <br /> ~ . <br /> ora a Fr <br /> om To: <br /> D <br /> ays C Re <br /> a is e; t . <br /> ques,. <br /> $ ted b~ <br /> We cannot be'respgnsible for damages caused by #aui.ty tires; bumper brackets; etc. Dannevik`s Towing assumes no res~ons~4iiity'fpr <br /> ~ Floss or:damage by theft, fEre or. ariyother cause beyond ou`r confrol; to any vehicle piaced.with us far storage or towing ' <br /> <br />