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.-_.o-- <br />F & Towing & Auto Salvage, Inc. A <br />-r 3061 Main' Street @Y 6444 <br />Springfield, Oregon 97,178 <br />Phonei(5411 7463615 at Toll Free 1'800-386-5615 <br />24-HOUR TOWING 45 <br />DATE F/ 20/ <br />/ <br />MAKE YEARNA &42 ~LIC.NOXW <br />BODY TYPE ( tM 1~ STATE n 1 G_ REG, NO. <br />DE <br />RIPTION <br />OF CHARGE <br />$AMOUNT <br />TOWED <br />TIC <br />' <br />fI <br />~ <br />L <br />G CJ <br />FROM <br />{N <br />~ <br />+ <br />TOWED <br />/ <br />6 <br />1 <br /> <br />~ <br />( <br />wllOll S <br />TO <br />V <br />, <br />{ <br />i <br />STORAGE <br />AT <br />RETOW <br />TO <br />FUSEES <br />OUTSIDE LABOR <br />& RECOVERY <br />L. <br />DOLLIE <br />AUTHORIZEDTOW 15P-~ <br />W1.~0 IS 1-~ <br />TOTAL <br />_n a G~ <br />Thx nmenignxe asree. inmuy and ae.emlly. In p.y F & M rowing & Amn Sal- CHARGES <br />7 <br />I h h' 10d f- da I - n (.in b <br />v.gc. nc. wnm l my l I ay. m m u nnv¢e l c mmum aCl a .c <br />for the mrvlces dcsaibcd above. Intnx.a al the mm of Id; pa annum from dale <br />.hall al.o be paid. The undcrslgncd funhm agrec and undcmmnd that F & M Towing & Auto Salvage Inc. may forward this account to their <br />mmm,, m agent for cullecbon upon the expirmion of said 30 days and in that mom the undcnigncd.lanlly and wycmily, agrec to pav a lam <br />n or aztiw i. inaimtcd to collttl the whole <br />payment acrvia cnutgc ol'ES.Iq, plus a malonabl, an..m,, , fm m be haM by the mun m e...... <br />or jun of ouch amount, plus mmmcyl fm ncttxsitamd by appeals fmn s decision of a Iowa cwri. <br />SIGNED <br />BY % <br />ADDRESS <br />The undnsigned agree, that F AM Towing & Auto balva,c. Inc. <br />,tall not be held liable for damage m Me above described vehicle <br />. iiipmcm. occunin, chum,thercmaval to minspon co" by <br />the po%ition, trcation or condititm of the vehicle F & MTowing& <br />Auto Salwge. Inc. will be held oumless by the madenigncd 0nm <br />all claim, of any nature wising (mm the ...oval of the vehicle <br />inm any location, public a-private. <br />INSURED'S NAME <br />SIGNATURE <br />INSURANCECO. <br />POLICY <br />AGENT <br />I have authorized F!& M'TOWING'&AUTO SALVAGE INC..b by tow my car and <br />I hereby. authorized my Insurance Company to make poyment'> to this towirg'agency on <br />Amount <br />my behalf. <br />5ignalure Date <br />OWNER'S <br />NAME <br />