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SERVICE/REPAIR THORIZATION <br /> mCALIFOgN1A CONTgACTOR LICENSE ppglp5 C�� <br /> �&ep N STOCKTON,CKTON CALIF.p5p5�1•SA <br /> P.o.Bax' <br /> p <br /> HONE Ppg�dga,� CALIF.pS�pl <br /> SALES . SERVICE . INSTALLATION OF PETROLEUM DISPENSING LUBRICATION&INDUSTRIAL SERVICE EQUIPMENT <br /> P.O.# <br /> AUTHORIZING NAME DATE <br /> BUSINESS �AyjAME <br /> AODgESS � � <br /> LOCATION <br /> i <br /> _C❑y sr. <br /> }9 ZIP <br /> PHONE <br /> AUTHORIZED REPAIR OF NEFOLLOWING OLLOWING EQUIPMENT <br /> pzli ^sem <br /> To T <br /> �r <br /> IIHEREBYAUTHORIZE7HEREPAp SE EWO <br /> INC.AS DESCRIBED ABOVE ON THE EQUIPMENT NAM _ <br /> REGULAR PRICES.I AGREE TO RK70 BEDpNEBYSiOCKTON SERyICES7AT10NE <br /> TERMS SA TO S.S.S.E.AND UNTIL PAID IN REPAIR PARTS ALL gEpglqP <br /> EQUIPMENT.1 FURTHER IL SUCH gEPAIq YUNP AND ARTS ARE T QUIPMENTCpMPANY <br /> EpUIPMENTFRp AGREE THAT S.S.S.E.WILL NOT LABOR ON DELIVERYO BE BILLED AT S.S S.E. <br /> I AGREE TO_B MFIgE,THEFT OF?OTHER CAU UNPAID BgLANCES SHgLLCONSOTITUTQEUfPA <br /> E INVpICED AND BE HELD RESPpNSIBLEF MENTOR ONI <br /> SES BEYOND S.S.S.E'S CONigOI. LEN ON THIS ' <br /> - WILL BE OR LO55 OR p <br /> THp - SUBJECT TOTERMS. AMAGE T <br /> D IGNATURE - --------- <br /> O SAID <br /> X �AA i. /� I TITLE <br /> FORM D 0075 / l�l,AAa.t ,_ �f/i, 1,14 <br /> dL <br /> CUSTOMER COPY <br />