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DIAMOND PETROLEUM SERVICES, INC. <br /> Ph: (925) 470-0803 • Fax: (925) 238-0871 • Lic #1005444 <br /> SERVICE REQUEST FORM <br /> 11 <br /> Site: �1 u` r�� W.0 / s Date: ' <br /> Address: , (..l���•� }�( �•,, r `` <br /> Client: Phone: -- <br /> Service Requested: f.•� c /�U e F ,-6 r ti4 t <br /> - I <br /> Description of Work Performed: <br /> i <br /> i <br /> f <br /> k\' <br /> R ' <br /> Work Preformed by: Arrival Departure Labor Travel Total Hours <br /> Time Time Hours Hours <br /> Guadalupe Sanchez ,` ~ . :.� ,'~ 'I ;7 �- <br /> i <br /> r I HAVE TME AUTHORITY TO ORDER THE WORK, WHICH HAS BEEN SATISFACTORILY PERFORMED,AS OUTLINED ABOVE IT IS AGREED THAT THF <br /> I SELLER WILL RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL THAT MAYBE FURNISHED UNTIL FINAL PAYMENT IS MADE,AND IF SETTLEMENT IS <br /> NOT MADE AS AGREED,THE SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY DAMAGES <br /> RESULTING FROM TE REMOVAL THEREOF. <br /> Customer Signature Date <br /> Print Name <br /> TCRMS:30 DAYS NFT. A FINANCE CHARGE OF 3%PER MONTH WILL BE CHARGED ON INVOICES UNPAID 30 DAYS FROM BILLING DATE IN ANY ACTION <br /> NECESSARY TO ENFORCE THIS AGREEMENT. THE BUYER WILL PAY REASONABLE ATTORNEY PEES AND COSTS 0CTERM3NlD BY TN!COURT. <br /> •RETURN CHECK POLICY *Return Checks will be charged a minimum of$25.00 each <br /> i—_ <br /> I <br />