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i:" :t r ova-.: 5:. h r ja: It ` r✓ +r a r>:',a a S-'~`---,a.. _.:...,-r ..v <br />F&M-Towing do Auto Salvage, Inc. <br />3001 Main Street W 6445 <br />Springfield, Oregon 97478 <br />Phone (5411'746-5615,• Toll Free 1-800-386-5615. <br />24-HOUR TOWING 4 <br />DATE 'Y 20 4-2 <br />MAKE YEAR 0 LIC. NO. 7 q F/3 L <br />BODY TYPE /',Q ~2 > 'STATE 47fc REG. NO. <br />DESCRIPTION OF CHARGE <br />$ AMOUNT <br />D <br />/ <br />S <br />' <br /> <br />FROM <br />r <br />r <br />) <br />WED <br />4 <br />k <br />/ <br />4 _ <br />G f <br />TO <br />r <br />O~ <br />G/ / <br />S <br />STORAGE <br />AT <br />RETOW <br />TO <br />FUSSES / <br />/ _ <br />OUTSIDE LABOR <br />& RECOV ERY <br />DOLUE <br />I <br />AUTHORIZEDTOW <br />l/v I L.Q IS <br />1 z14 <br />TOTAL <br />CHARGES <br />;•-C~ <br />S <br />The undcrrigncd ag.a, jointlyand uvcrally. m NY F & M Towing &Aum Sal- <br />aovc <br />vatic. Inc wtlu ihmy 1301 days!. nos dam of.crvmc,t camountnel mh h <br />for the.vices described above. Ineresr at the ram of 10/Y, pct nature froan date <br />nhxll oleo be paid. The ulectio upo er ogre. undo>und F in M Towing Aum Salvage.Inc may froward 0h acwum ..hale <br />.moseys orapcm for collection uponbe the c.pimtioo o f.uid]0 da, and in that cvemthe e under.igned.jointly and wvcmll,, agree to payola. ' <br />paymcni .acid.. eM1aryc of 55.00, plua a ...Doable amm~cy'.. fee m be f xcd by the coon in cau.uim or action ix inuitmcd m collet the whole <br />of pan or.mh amount. plu.a anomey's fco ncaav.i[amd by appeals from a decision ofa low. coon. <br />SIGNED <br />BY x <br />The undersigned agree that F & M Towing & Auto Sdvagc. Inc. <br />zhall na be held IiaMC fw damage m the above dcsaibcd vehicle <br />INSUREO'S NAME <br />w aryipnrcnt. mean ing during the removal or transport caused by <br />the position. [mat inn or condition of the vehicle F&MTOwing& <br />SIGNATURE <br />Auto Salvage, Inc. wdl be held harm..,, by the mdcraigned from <br />all cl.iims of any nti arlving from the remnwl of the vc icte <br />INSURANCE CO. <br />fnun any location. public or private. <br />POLICY ii <br />x <br />AGENTA <br />Thane authorized. F'&.M TOWING AUTO SALVAGE INC. to tow my car and <br />I hereby authorized my Insurance Company to make payment to this towing agency on, <br />Aot <br />my behalf. <br />Signature Date <br />OWNER'S <br />NAME <br />ADDRESS <br />