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~T;`, <br /> ' i ~ a <br /> TGw11VG SERVICE, IIV'C. ~..lt's time to expect more from a towing company <br /> P.4, Box 24203 Eugene Springfield Fax <br /> Eugene, OR 974D2 X54 ~ <br /> j 342-2386. X54 i} 126W0222 {54 i j fi83~6701 <br /> Date. Call # StartTime AM Finish Time AM Billing Code P,O. # 1 Case # ~ ~ <br /> ~ ! r f <br /> ..Name Nome Phone # -Work Phone # ~ : <br /> :Address ~ ~ ~ - <br /> :ti <br /> . : <br /> <br /> . ~C ~ State ~ - . Gdometer Driver~~I Registered Owner <br /> '1 <br /> ' Year Make 1 Model _ Color <br /> State Plate # <br /> Vin # <br /> is ~ ~ ~ ~ <br /> . ~ <br /> Lgpocation of Vehicle <br /> d <br /> ' Tow to Dest~nattan <br /> i <br /> ~ <br /> Insurance Policy # Agent's Name <br /> I authorize to pay Dannevik's Towing,for the service provided on <br /> I <br /> j, I <br /> Reason.#orTow Milea a LaborTime Extra Person K.. <br /> ~1!s <br /> ? Accident ~ _ . <br /> ? Abandoned Beg. ~ Finish Finish Y <br /> ? Tow Zone <br /> Y, d Stolen . Finish Start Start N <br /> ? Arrest : Dr~v~r # <br /> F ~ .Start ~ ~ ~ Total .Total ~ <br /> . D Impounded ~ , <br /> UnknoWh <br /> V . Total : <br /> ~ Date .1 <br /> Equi : I Serv Towtn Char es Personals Taker~~ <br /> ices <br /> - <br /> cam. <br /> Recovery Tow ~ ~ , <br /> Ins ected b Date ~ <br /> ' Labor Miles . <br /> Clean Up Dollies' - Released To B <br /> ~ , <br /> L Lock out Drive Line . <br /> Method of Payment Cash <br /> E~ <br /> Gas Delivery Jumpstart ~ <br /> Check # <br /> i ' , <br /> 2 Gal. Gas Re-Tow <br /> Ck Guarantee # <br /> Flat Ti re.- Y , ~ F : R ~ r C # l ~ ~ _ <br /> T. Miles: ~ . <br /> i ~C b~ <br /> Stanrd By Storage <br /> _ Exp. <br /> f <br /> ~ Dispatch Fee Gate Fee <br /> 4 GDL # Exp. <br /> Flares 2nd Truck Authorized Si ~ nature Date ` <br /> 2nd IT 1S UNDERSTOOD THAT IF FOR ANY REASON ` <br /> Outside Charges .Truck Miles THIS CLAIM 1S REFUSED BY MY INSURANCE <br /> ~ COMPANY 1N PART OR IN FU~.L, I WILL ASSURE ~ ~ . <br /> f'. <br /> Total Tatal RE - NSIBILIT 1=4R PAYMENT. <br /> ~ <br /> ' ~ ~ <br /> Disco Grand Tot <br /> Indicate Remarks~or Dama ed Areas on back of Pink Invoice. k _k <br /> _ <br /> 1 _ , <br /> Vel~icle~Sfiarag~ t=ram. To: ~ Days C ~ Re uested b <br /> : W~ canngt.be res onsible for dams es.caused b faul tiles, hum er brackets, etc: Dannevik`s Town assumes ho res onsibiG for ! <br /> P 9 Y~ p 9 (J tY <br /> l - <br /> Toss or damage;by theft, fire oC any othercauSe bejian~ our control; to' any vehicle placed with us for~storage or towing <br /> - . . <br /> _ _ . <br /> <br />