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. ~ ~ -.--r <br /> f ~ ` <br /> ~ S" Sb <br /> TOWING SERVICE, ~1VC. ...It's time to expect more from a towing company <br /> ~ ~ P.O. Box 24203 Eugene Springfield Fax <br /> t.. <br /> ,Eugene, 4R 97402 {54~) 342-~38fi ~54~ <br /> j 72fi~0222 ~54~} 683-6707 <br /> Date Call # .Start Time AM Finish Time AiN Billing Code P.D. # 1 Case # - <br /> f <br /> " ~,;~"..:Name. Home Phone# ~ Work Phone # <br /> <br /> r iy', <br /> y ~ Address _ <br /> ~ ~ <br /> ~ - <br /> ~ . .G~! ~ State ~ :odometer Driver"I~Registered owner <br /> E: Year Make 1 Model Colorer <br /> ~ <br /> Vin # State Plate # <br /> f Location of Vehicle <br /> . ~ e <br /> ~ Tow to Destmat~an <br /> ."r .~..ry Pa_ . Ih . L:t".,fie':.-'... v'; : ~.4 ~ 'v ~iY:-i;5.~....415`aH-aN?° ,~k a <br /> i; <br /> ~ Insurance Polio # A ant's Name <br /> Y 9 <br /> s. I authorize to pay Danneviks Towingfor the service prov+ded on <br /> 4'' <br /> ~a ~ <br /> Reason forTow Milea a EaborTime Extra Person Ke s ,k <br /> ? Accident <br /> ~ ? Abandoned Be . ~ Finish Finish Y <br /> ? Tow Zane f~ <br /> q Stolen `Finish .Start:" ~ Start <br /> ~ ? Arrest Dri~ier # - <br /> i <br /> : I mpourded Start Total Total <br /> ~y ~ ? Unknown <br /> . <br /> ~ Total <br /> 1 ~ <br /> personals Taken B Date <br /> y q .p Towing Charges ~ ~ ~ <br /> ~ E u~ 1 Services. <br /> ~ Recovery Tow ~ <br /> ~ <br /> Ins acted b Date " <br /> Labvr Miles ~m. ~ p ~ , <br /> s <br /> Clean Up Dollies ~r Released To ~ <br /> Lock Qut Drive. Line <br /> F: <br /> Method o Payment Cash <br /> ~ '..Gas Delivery Jumpstart " <br /> - Check # <br /> 2 GaI. Gas Re-Tow <br /> Ck Guarantee # <br /> E- FIat~Tire L. ~ ~ R~:~~M#le~s~r= ~ ~:,;;a~,:~ CC 1 r <br /> # <br /> ~Stora <br /> Stan~By ge <br /> Exp. <br /> ~ Dispatch Fee Gate Fee - <br /> c; ODL # Exp. <br /> f~ Flares 2nd Truck ~ Authorized 5i nature Date <br /> 2nd IT i5 UNDERSTOOD THAT lF FOR ANY REASON <br /> i. Qutside Char es Truck Miles THIS CLAIM IS REFUSED BY MY INSURANCE <br /> g <br /> c~` CQMPANY IN PART OR IN FULL, I WILL ASSURE <br /> Total Total RESP,O SIBILlTY FUR PAYMENT. <br /> ~ ~ ~ J <br /> f~fp'.;~~ Discount ~ ° Grand Total ~ X ~ ~ <br /> In' .b r .V f~ h <br /> n <br /> Indicate Remarks or Dama ed Areas on back of Pink Invoice. - . <br /> " <br /> Vehicle Storage From To ~ ~ Days G $ Requested bj~: <br /> We cannotbe: res~onsibie for.damages caused by faulty tires, bumper brackets; etc.. Dannevik's Towing assumes r~o respgrts~bility #or . , <br /> r,., loss.or damage by #heft; fire. ar any other cause beyor~~ our control; to any Vehrcie,placed with us:far~storage ar towing: <br /> <br />