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1~ ~ ~ ~ , <br /> F l <br /> : TgwlN ~r $FRV~C,+E, ~~C. ...rf's flme fo expecf more from a fowing company <br /> - P.D. Box 24203 Eugene Springfield. Fax <br /> Eugene, 4R 97402 {54 342-238fi X54 726-0222 {54 fi83-6707 <br /> Date Call # StartTime Finisi' Time AM Billin Code P.G, # 1 Case # <br /> AM <br /> Name Nome Phorie # : Work Phone # ~ ~ <br /> <br /> r Address <br /> 5` ~ - ,a <br /> . ti <br /> C~ ~ State ` Z!Q Odometer ~ ~ ~ Driver l~ Registered Owner <br /> t.~ <br /> ~ ~ ~ <br /> Year Make 1 Model Color <br /> Vin # ~ State Plate # 'a <br /> ~F <br /> 1 ya a yyl d raw.r a.w a~ ~ ~a`"^ ` 3 . <br /> 1•: I <br /> Location of Vehicle <br /> ~ <br /> Tow to Destmat>lon ~ - <br /> Insurance Polic # Agent's Name <br /> y <br /> ' ' far the service rovided on <br /> I authorize to pay Dannevik s Towing p <br /> Reason for Tow Milea e . Labor Time Extra Person K. <br /> e~Ws. <br /> ? Accident <br /> ? Abandoned Be . ~ Finish Finish Y <br /> g <br /> Q_Tow Zone <br /> Stolen ~ ~ Finish ~ ~ Start Start ~N <br /> C] Arresf Driver <br /> ounded:; Start ~ Total ~ ,Total <br /> ? Imp.. ~ . <br /> p~ Unknown . <br /> ~ <br /> ~ ' <br /> ~ ~ ~ , otal <br /> . <br /> ~ ui .'1 Services Towin ~ Char s Personals Taken B Date <br /> Recovery : Tow a <br /> t - Ins ected b Date <br /> Labor Mies ~ ~ <br /> x <br /> .~r~ g <br /> Glean U Dallies ~ ~ r~, ~ Released"I'o <br /> p <br /> Lvck Out Drive.. Line Method of~Pa~yment Cash <br /> Gas Delivery ,lumpstart ~ Check # <br /> 2 Gal. Gas Re-Tow <br /> Ck .Guarantee # <br /> Flat Tire:. ~ ~alJl~les~ <br /> ' GC <br /> 5ta~d By Storage <br /> Exp. <br /> Dispatch Fee Gate Fee ODL # Exp. <br /> Flares 2nd Truck Authorized Signature Date <br /> ~ ~~d IT IS UNDERSTOOD THAT lF FOR ANY REASON <br /> Outside Charges Truck Miles THIS CLAIM IS .REFUSED BY MY INSURANCE <br /> ~ COMPANY IN PART OR IN FULL, l WILL ASSURE <br /> ~ IBILITY FOR P~YMENT. <br /> Total Total RESP, <br /> + i <br /> ~ ~ <br /> Discount ~ • . Grand Total <br /> Iridicate Remarks or Dama ed Areas on back of Pink InvoNCe. A <br /> . ~ Stora e m ~ To Da s @ $ Requested by ; <br /> .Vehicle Fro Y _~~--r . <br /> r <br /> we cannot be responsible for damages caused by faulty;:t~res; bumper brackets; .etc. Dannevik's 7owirig assumes no kespansibiiity for r; <br /> . <br /> ~r.": lass or damage.by #heft;.fire or any other:cause ~eyonb our control, o:ariy vehicle;piaced with.us for'storage or towing. <br /> . <br /> tem. . <br /> <br />