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.f~. ~ ~ ~ <br /> $7 " ° <br /> TQWl~VG $EF~1/~CE~ III~C. .~.lt's time to expect more from a towing company <br /> _ P. Box 24203 Eugene ~ Sprr"ngfield Fax <br /> Eugene, 4R 97402 X54 i~ 342-238fi X54 i~ 726-0222 {54 i~ 683-6107. <br /> Date Cali # StartTime - p Finish Time AM Billies <br /> _e P.4. # 1 Case # <br /> ~ FPM ~ ` ~ P ~ <br /> Name ~ - ~ Home Phone# Work Phone # ` <br /> ~ ~ - ~Q <br /> r Address. ~ ~ ~ - - , <br /> r _ <br /> .C~[ ; . ~ State Z:,~ ~ ~dometer~ . ~ Driver 1 Registered Owner <br /> . ~ ~ ~ Year Make 1 Model Color ~ ~ <br /> ~ <br /> . s ~ ~ <br /> - Vin # _ State Plate # <br /> _ Location of Vehicle <br /> Tow to Destination <br /> ~v <br /> <br /> . insurance Policy # Agent's Name <br /> l authorize to pay Dannevik's Towing;for the service provided on <br /> Reason far Tow Miles a Labor Time Extra Persons KeXs_ <br /> ? Accident ` <br /> ned Be . ~ ~ Finish Finish Y <br /> . ? Abando g <br /> r, TDW zorl,~ <br /> ini h 5tart - Stan ,;N ~ <br /> Stolen F s <br /> t C] Arrest ; - <br /> Impounded Start. Total ~ Total <br /> Unkn wn - _ z. , <br /> ti , ~ Total rr <br /> en B ~ Date . <br /> E ui .1 Services Towin Char es . f Per <br /> ~ ~ sonalsTak <br /> ~ ~ ~ - <br /> ~ Recovery Taw <br /> Ilns~ected~ Date <br /> Labor _ Miles V ~ ~''f <br /> J <br /> B <br /> Clean Up Dollies ~ Released To . , X <br /> Lock Out Drive Line Method of Pa ment Cash <br /> :Gas Delivery Jumpstart Check # <br /> ~ <br /> 2 Gal. Gas Re~Tow Ck Guarantee # <br /> . FlatTire .w:~ R.T..Miles.. ~CC t - <br /> l. # <br /> M Stora e <br /> s~ Stan~~~~By g <br /> ~ Exp. <br /> ` h Dispatch Fee Gate Fee <br /> ~DL # Exp• <br /> Flares 2nd Truck... Authorized Si nature .Date <br /> a~ 2nd IT lS UNDERSTOOD THAT IF FOR ANY REASON. <br /> Outside Charges Truck Miles ' THIS GLAIM 1S REFUSED BY MY INSURANCE <br /> ~ COMPANY IN PART OR IN FULL, I WILL ASSURE <br /> . Total ~ Total ~ RESP~O~IBILITY FOR:PAYM,ENT <br /> Discount Grand Tota <br /> ~ <br /> ~ Indicate Remarks or Dama ed `Area s on .back of Pink Invoice. <br /> To Days @ $ : Ra uested b <br /> Vehicle Stora e ~ From <br /> r We earinatb~ respor~sibfe for.~amages caused by faulfy tires, bumper brackets, etc; gannevik's Tauu~ng assumes na resparisibilltyfior ~ <br /> ~ ~ <br /> ~1 loss or;damage bY.theft; fire qr any other Douse beyond our control,;to any vehicle pfaced with us fors#orage ar towing Y ' <br /> ,f <br /> . <br /> <br />