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. SERVICE/REPAIR AUTHORIZATION <br /> 9tmKT(oa 91ERWO R <br /> �4Q�DOO a�©NJOp[��G'74 COO�,0� <br /> CALIFORNIA CONTRACTOR LICENSE 309105 A-C61/D40 HAZ <br /> BOB N.UNION ST.STOCKTON,CALIF.95205 <br /> P.O.BOX SOB STOCKTON,CALIF.952D1 <br /> PHONE 209/061-8393 <br /> SALES SERVICE • INSTALLATION OF PETROLEUM DISPENSING LUBRICATION a INDUSTRIAL SERVICE EOMPMENT <br /> P.O.# _ DAT <br /> AUTHORIZING NAME COMPANY NAME <br /> BUSINESS ADDRESS ST. <br /> LOCATION <br /> PHONE <br /> CITY ZIP <br /> Si0G IC—1-,(3i"1 <br /> AUTHORIZED REPAIR OF THE FOLLOWING EQUIPMENT <br /> 1L --- <br /> L Z )e T <br /> TIS.�►� A PJ��i.�ra� p C�Ip l7l� �" <br /> sz. <br /> I HEREBY AUTHORIZE THE REPAIRISERVICE WORK TO BE DONE BY STOCKTON SERVICE STATION EQUIPMENT COMPANY <br /> INC.AS DESCRIBED ABOVE ON THE EQUIPMENT NAMED HEREON.ALL REPAIR PARTS ARE TO BE BILLED AT S.S.S.E. <br /> REGULAR PRICES.I AGREE TO PAY CASH FOR SUCH REPAIR PARTS AND LABOR ON DELIVERY OF EQUIPMENT OR ON <br /> TERMS SATISFACTORY TO S.S.S.E.AND UNTIL PAID IN FULL ANY UNPAID BALANCES SHALL CONSTITUTE A LIEN ON THIS <br /> EQUIPMENT.I FURTHER AGREE THAT S.S.S.E.WILL NOT BE HELD RESPONSIBLE FOR LOSS OR DAMAGE TO SAID <br /> EQUIPMENT FROM FIRE,THEFT OR OTHER CAUSES BEYOND S.S.S.E'S CONTROL. <br /> I AGREE TO BE INVOICED AND WILL BE SUBJECT TO TERMS. <br /> AUTHORIZED SIGNATURE TITLE <br /> X <br />