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SERVICE/REPAIR AaHORIZATION <br /> uf0 Gc C340o C G3d�C�C� <br /> CALIFORNIA CONTRACTOR LICENSE 309105 A-C61/090 HAZ <br /> M N.UNION ST.STOCKTON,CALIF.95205 <br /> P.O.BOK 506 STOCKTON,CALIF.95201 <br /> PHONE 21AIA"-6333 <br /> SALES SERVICE INSTALLATION OF PETROLEUM DISPENSING LUBRICATION&INDUSTRIAL SERVICE EQUIPMENT <br /> DATE <br /> P.O.# <br /> AUTHORIZING NAME COMPANY NAME <br /> ADDRESS ST' <br /> BUSINESS <br /> LOCATION <br /> CITY ZIP PHONE <br /> AUTHORIZED REPAIR OF THE FOLLOWING EQUIPMENT <br /> 1 HEREBY AUTHORIZE THE REPAIR;SERVICE 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 /> FORM 0 0015 <br /> CUSTOMER COPY <br />