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'F & N Towing & Auto Salvage, Inc. <br />3001 Main Street 642:4 <br />Springfield, Oregon 97478 <br />Phone (541) 746-5615 to Toll Free 1-800-3 8 6-5 6 1 5 <br />24-HOUR TOWING /"y <br />OATE_(1 / 20 <br />MAKE- 111 YEAR LIC. NO. ~f • / <br />BODYTYPE7 STATE REG. NO. <br />DESCRIPTION OF CHARGE <br />$ AMO <br />UNNT <br />G f <br />D <br />F~ <br /> <br />/ <br />° <br />FROM <br /> <br />r <br />TOWED <br />TO <br />STORAGE <br />AT <br />RETOW <br />TO <br />FUSEES <br />OUTSIDE <br />LABOR <br />RECOVERY <br />B <br />~G <br />DOLLIE <br /> <br />AUTHORIZEDTOW <br />TOTAL <br />❑re undcnigncd agra.joimly <br />and uvmally, to pay F & M Towing &Amo Sal- <br />CHARGES <br />yJ q <br />far the mviccsdcxcribcd d6- ,,Imcrcvl al the tatcaf de per annum from dvc _ <br />shall who paid. The uMo,coupoPonhcragrce and undccaidnd n F& M Towing ic Amu Salvage lnc.,my froward t n, aecoumto their <br />rccw pay whole _ <br />and in the coucn case .witu ule faintly andscv .ag <br />anomcye orruciu fm ll500. upon nable ofai s <br />pay;ncm.crvi<c change ge of $ SS plu. a reasorcmonabl ieancy s f fec ce ts to be fixed cd b by the coon in au orramion is instituted tuted tmcd mcollect hc whole _ <br />or pan of%wh amount. ~plus /alwm/cy,, rec.roccevolveed by wppca/L~s from/a/1~c on of aallower coon. <br />SIGNED !A L/V_LyI~J(I.IsII f/ l /)qn BY % it M I f/V/ <br />The unde;aignN agree, Thai F & M Towing& Anne, Sabagc. Inc. <br />,hall not be held liable for damage to he above described vehicle <br />or equipment, oucnaing during the icrrwval or nnnapmt cauacd by <br />the position, t«adon ar cbndition ofthc vehhchc. F & MTowing& <br />Amo Salvagh, Inc. will be kid humleas by the undcnigncd from <br />nil cbbns of any nature anong frtan the removal of the vehicle <br />Rpm any location, public or husate. <br />x <br />INSUREDS NAME <br />SIGNATURE <br />INSURANCE <br />POUCY x- <br />I hove authorized F & M TOWING & AUTO SALVAGE INC. rotow my car and - <br />b <br />I hereby dulborized my Insurance Company to make paymeul Ig t{YMpvirg agency.on <br />my behalf. [[f Il fIUU. <br />Signature Date <br />OWNER'S <br />NAME ITO s'r/w / - <br />•te. ~^ADDRESSr ~mf~o'!~~ 'G , <br />