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F & M Towing & Auto Salvage, Inc. <br />3001! Main Street W 6425 <br />Springfield,.Oregon 97478 <br />Phone (541 7465615 a Toll Free 1-800-386-5615 <br />24-HOUR TOWING <br />rR DATE/ <br />MAKE 4z Vl/-d YEAR 11'ej LIC. NO. W q O <br />BODY TYPE G ~~i /ZO 6TATE REG. NO. <br />DESCRIPTION OF CHARGE <br />$ AMOUNT <br />TOWED <br />S <br />J <br />FROM S/C <br />aA <br />TOWED <br />~ <br />TO <br />EJ <br />STORAGE <br />AT <br />RETOW <br />TO <br />FUSEES <br />OUTSIDE LABOR <br />a RECOVERY <br />DOLLIE' <br />AUTHORIZEDTOW 44 - ~ ~aISOF-Y~~ <br />TOTAL <br />Tbc undmi ncd a cc, ointl d xvmall m F & M Towin & Amo Sal- CHARGES <br />k V 1 Yam ri MY g <br />far the services described above. Interest at the rare of 10% per annum fmn doc <br />:hall also be paid. The undersigned fmfin agree and un le.nead that F A M Towing & Auto Salvage, Ina, may fmwmd rhte account or their <br />wwrn,s in agmu for eollemion upon the careworn of said 30 days and in that event the undersigned; ioinfly and severally. agree m pay a laic <br />payment service charge of S5 M. plus i reassemble anamcy's fee in be fixed by the roan in ease suite or action is i ,mated or mllea tse whMe <br />ar part or such amount plus ananey'x fen naceesiMmd by appeals fmn a decision of a lower court. <br />SIGNED <br />BY x <br />ADDRESS <br />The undersigned agree Thal F A M Towing & Arm Salvage, Inc. <br />shall not be held liable fear damage to the above dnnibcd vchielc <br />INSURED'S NAME <br />or equiryrcm, aceurring during the removal or manywn caused by <br />the posiuon,location or eondiron o(the vehicle F&MTowing& <br />SIGNATURE <br />Auto Salvage. Inc, will be beW harmless by the undersigned from <br />all claiins or any nature arising fisem the rmnoval of [be vehicle <br />INSURANCECO. <br />Ram any location. public or M'ivatc. <br />POLICYA <br />x <br />AGENTY <br />I have authorized F & M TOWING & AUTO SALVAGE INC. to tow my car and <br />I hereby authorized my Insurance Company to make payment to IhiS lowing agency on ' <br />Amami <br />my behalf. <br />ADDRESS`' <br />