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F & Towing & Auto Salvage, Ine. <br />3001 Main Street 64 TO <br />Springfield, Oregon 97478. <br />Phone (541) 746-5615 as Toll Free 1-800-386-5615 _ <br />24-HOUR TOWING ' <br />DATE / Zl 20 <br />MAKE <br />• / r a / Y1EAR UCNOJ ~ <br />BODYTYPE-STATE / REG. NO. ' <br />DESCRIPTION OF CHARGE <br />$ AMOUNT <br />TOWED ` <br />FROM <br />TOWED <br />TO ! a <br />STORAGE <br />AT <br />RETOW <br />TO <br />FUSEES,,., <br />OUTSIDE LABOR <br />& RECOVERY <br />DOLLIE <br />AUTHORIZED TOW <br />TOTAL <br />The undn,ipned agrec.joindy and wvcnllY. w faY F & M Towing & Auto Sal- CHARGES <br />t l r the t m sin fmah above <br />. I mi I <br />30 d <br />r- <br />t <br />i <br />a <br />vzt,c, ne. wr nt uy( ) "ran aeu wrvtee, amu <br />far the wr vice, dcwntped above. Intere,i al the rare er 110% far annum from date <br />,hall elm he laid. The mid.,ed funhcr agree and umc,ttad thin F & M T.wing& Auto Salvage, Inc. may froward do, eccoum to their <br />anomcys or agent for collccllonu the exfiutian.Luid1lday,and in that event the undersigned. jointly and severity, agree to pay a laic <br />pem,crvicc char or 15.00 aiia,pnabla ntmncy fwmMf, by thermal in eau xuimwmi.n is instituted meolleci the whale <br />m fan oLmch amount. lm d fyl, rac, mcccaialed by of al, from de," on ola low n. <br />SIGNED <br />BY x WWW ~w <br />ADDRESS <br />The andero rued agnr, thin F & M T.wing& Aunt Sillvage. Inc. <br />.hall not be held liable for damage to The above dmobcd vehicle INSUREDS NAME <br />or equlpmam. diem m,during,hc removal....., port eauwd by <br />the Notion. location or condo ion ofncc vehicle.F&MTowing& SIGNATURE <br />Aunt Salvagc, Inc. will he held haimlem by the undersigned from <br />all claim, of any nature code, from me rmnoval of the vehicle INSURANCE CO. <br />from any lacer..: public or private - <br />POLICY s <br />x AGENTV <br />19>,ave authorized F & M TOWING,& AUTO SALVAGE INC. to tow.. my car and <br />Thereby authorized my Insurance Company to make payment tb Ibis bowing agency on <br />my behalf. Aar.am <br />Signature Dote <br />ADDRESS <br />