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T & M'Towing & Auto Salvage, Ina. <br />3001 Main Street W 6424 <br />Springfield, Oregon 97478 <br />Phone,(541(, 7465615 a Toll Free 1-800-3 8 6-5 6 1 5 <br />24-HOUR TOWING / y <br />DATE. /!5/ ,d~20 <br />MAKE Iv~/fJ~~'t YEARRf LIC.NO. ~'~N <br />BODYTYPE `i STATEC-* REG.NO. <br />'.DESCRIPTION OF CHARGE <br />$ AMOUNT <br />TOWED <br /> <br /> <br />J <br />FROM <br />TOWED <br />TO <br />STORAGE. <br />AT <br />RETOW <br />TO <br />FUSEES <br />OUTSIDE LABOR <br />I <br />aRECOVERY <br />d <br />f <br />M <br />ANN <br /> <br />DOLI:IE <br />AUTHORIZEDTOW <br />TOTAL <br />. <br />c" <br />me pnecnigixH agree. iaimlrana.eve~lly. m^p.r^F&Mror.in~&Aan sal^ <br />CHARGES <br />or the scrvim eescdUCd above. Imcrcv n IIIC nuc <br />.hall rho M paid. nc unddcvigacd funhcr agree o. <br />.pane" orSgawl fc. mllmbn upon the npiurioo <br />paymcnl xorncc charge of S5 W. plus 4, cuwmbic ai <br />cu pan of xuoti eiiouni. pplyus/apronccyy ss rrrecs(ncccn,i <br />SIGNED <br />BY /y <br />=Salvegc. Inc, may fuwnd ihii aemunl Ia share <br />undavgi d.loinllY indcevcNln?Itrcc to pay a Imo <br />in aac 'uirc or amian i. inviiu¢d Ib collCa nc~ wfiolc <br />f11c IlMCnigned a,oc. m.r F & M Towing & Aulo Salvage, I., <br />,hall not be held liable ford age Io the above deenihH vcisield <br />INSURED'S NAME <br />a'r equip c I &cu 'in6 do nllthe rcinoval ci um"ar eausod by <br />Inc posit pn Iwafon awndl naf the vehicle F&MTdwing& <br />'SIGNATURE <br />'Aino Salvage. Inc. will beheld humla l by the undcr igr M from <br />all, claim% of any namm arising from the mmoval of.. Ihc. schiele <br />INSURANCECO. <br />from any 1.6iiad: public urjiiivmc. <br />POLICYA <br />x <br />I have authorized FAfiiA TOWINGS AUTO SALVAGE INC. lo'low my -car <br />I hereby authorized my. insurance Company to make payment <br />Ama <br />my,beholf. <br />OWNER'S <br />.NAME <br />lowing agency on <br />A <br />