Laserfiche WebLink
CPG # T0: OFr' , REVENUE AND RECOVERY ,../ COPY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> PAUL'S AUTO REPAIR <br /> C/O NAMEGUARANTOR SSN <br /> PAUL W WONG <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1146 ENTERPRISE ST STOCKTON CA 95204 209-462-6828 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-462-6828 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE RM CRM INT MONTHLY PAY AMT M ROB <br /> 11966 HAZMAT 3/20/10 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Nn <br /> 230 026000.0 2010 Hazmat Fee $100.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 TA IF <br /> Hazmat Penalty Fee $10.00 <br /> TOTAL $159.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PAUL'S AUTO REPAIR 209-462-6828 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1146 ENTERPRISE ST STOCKTON CA 95204 <br /> SIIGUSF, CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PAUL'S AUTO REPAIR 209-462-6828 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1146 ENTERPRISE ST $TOC ONCA 95204 <br /> REPARED BY 1 CHECKED BY JDATE F ..7 ./ COL 20 (3M) <br />