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F & M Towing & Auto Salvage, Ina. <br />3001 Main Street W 6447 <br />Springfield, Oregon 97478 <br />Phone`(541( 7465615 • Toll Free 1-804386-5615 <br />24-HOUR TOWING <br />DATED 20 <br />MAKE t YEAR t~ AL"'LIC.No._ <br />BODYTYPE 'I r a h ' h4k~ STATE OO REG. NO. <br />DESCRIPTION OF CHARGE <br />$ AMOUNT <br />TOWED 7l p <br />ff <br />-V <br />FROM <br />: <br />~y <br />TOWED <br />) <br />TO t <br />/ <br />STORAGE <br />AT <br />RETOW <br />TO <br />L <br />FUSEES 1 G ° <br />i <br />f'J <br />OUTSIDE LABOR <br />& RECOVERY <br />DOLLIE <br />AUTHORIZEDTOW T~M1"'I `-1 ~'1 L'1 <br />WIV1~I`. Fi <br />TOTAL <br />CHARGES <br />j G <br />The undasigned agree, jointly and seve afy. to pay F& M Towing & Auto Sal- <br />for Inc services deso Inbbed above. Interest thal the rare of 1041, per annum fivan date <br />allun ao be pai& d. Thc undersigned d further agree and understand! aid 0 that F A M Towing Aldo Salvage. Inc. may forward Ih i. account to Ibcll <br />00 ts <br />anmrsntrage for f,fatianupon Ihecsnaofsaidday, and to but them the undersigned, jointlyand mwuled to acneto the stale <br />paymem service chat ge of 55 00. plus mble blc anonwy% fm to k fixed by by the loon in cave suite or action is imtilmd cullttrthc whole <br />of pan of such amount, plus' allomfy 'fees neccessitued by appcals from a dccixian ofa lowo coon. <br />SIGNED <br />BY K <br />The undersigned agrre, That F is M Towing is Aum Salvagc, Inc <br />shall not be held liable f rdamage m the above dewnbed vehicle <br />or equipuenl, oecuo ing dunng the removal or broo,on caused by <br />the poxilmn, location m condilion of the vehicle F & M towing & <br />Alto Salvage Inc, will be held harmless by ]he under still fimm <br />all daitne of any nature arising from the ranoval of the vehicle <br />b mrs any locallon, public or private. <br />INSURED'S NAME <br />SIGNATURE <br />INSURANCE <br />POLICY 9- <br />x <br />I have authorized F & M TOWING & AUTO SALVAGE INC. to row my car and <br />I hereby authorized my Insurance Company to make payment to this rowing agency on <br />A l <br />my behalf. <br />Signature Dote <br />OWNER'S <br />NAME <br />ADDRESS <br />