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SERVICE/REPAIR AUTHORIZAIIUM <br /> AT MIACO EC <br /> 000 040 NNUNION STpSTOCKTONRCALIF�..05405105 01 BA <br /> P O.00%500 STOCNTORAO%i O- T5T3i11 <br /> PHONE 2NA"-0033 <br /> SALES SERVICE INSTALLATION OF PETROLEUM DISPENSING • LUBRICATION\MOUSTRIAL SERVICE EQUIPMENT <br /> DATE <br /> P.O.0 i/aq- '�;o <br /> COMPANY NAME <br /> AUTHORIZING NAME � <br /> ST. <br /> ADDRESS <br /> BUSINESS <br /> LOCATION 5000 � ZIP PHONE <br /> CITY <br /> AUTHORIZED REPAIR OF THE FOLLOWING EQUIPMENT <br /> C 4 <br /> / SL, � Imo//�T.r N•* '� � <br /> 7/7/ <br /> INC.HEREBY <br /> DESC AUTHORIZE <br /> THE E ON LATHE EQUIPMENT NAMED HEREON.ANE BY O L REPA CTON R PARTS ARE TTOE EUBILLED ATOS.SSNE <br /> REGULAR PRI E JAG AGREE TO AY LASH FOR SUCH REPAIR PARTS AND LABOR ON DELIVERY OF EQUIALIENPMENT ORTHIS <br /> ON <br /> TER S SATTl TOTHY O S REE MAT U TILPI IN FULLS.S.S.E, ILL NOT BEY EID LDA RESPONSIBLE FOR LOSS ORBALANCES SHALLUDAMAGE TOO SAID <br /> EQUIPMENT ROM FI THE OTHER ES BEYOND S.S.S.E'S CONTROL -- <br /> I AGREE TO El V IC DA D ILL BE E TO TERMS. TITLE �Sr <br /> IZ SI N <br /> X <br /> FORM#0015 CUSTOMER COPY <br />