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JUL 30 2004 ii : 3enm HP LASERJET 3200 p. 5 <br /> DILLARD TRUCKING,INC., <br /> dba DILLARD ENVIRONMENTAL SERVICES 42-72 <br /> RO'BOX 579 <br /> BYRON,CALIFORNIA 94514 <br /> PHONE:(925)634-6660 FAX:(925)694-0569 <br /> DATE PM JOB# CUSTOMER SITE ADDRESS CITY INT PM <br /> Axe X4,40 <br /> •- , '� •� <br /> A <br /> DELIVERY PICKUP TIME UNIT# TYPE RT/OT LINER TAR <br /> LIST ANY DAM GE[MISSING PARTS,IN DETAIL <br /> UNIT# UNIT# <br /> :TOP <br /> FRONT FRONT <br /> Q DEFT SIDE Q CJ LEFT SIDE Q <br /> TOP TOP <br /> 1 �` <br /> FRONT FRONT <br /> Q RIGHT SIDE Q Q RIGHT SIDE Q <br /> FRONT EA FRONT REAR <br /> DRIVER SIGNATURE TE TRUCK# <br /> By accepting delivery of r nted Items,customer agrees to all terms and conditions of this rental contract. <br /> Customer acknowledges receipt of rented items in good order.with excep ' snotedabove. <br /> CUSTOMER SIGNATURE(*) DATE �` TRUCK# <br /> `No one at jobske to receive units, driver signs for customer. <br /> THIS IS NOTAN INVOICE <br /> ESTIMATED COST FOR REPAIRS: Maiied invoice to follow <br /> REPLACEMENTTARP TOP -� OUTSIDE REPAIRS. <br /> REPLACEMENT PARTS <br /> WHEEL(S) HINGES F RAILS I BODY .� <br /> DOOR E LOCKS . 1 TOP I J, PAINT <br /> Terms and Conditions:Bills are due and:payable within 30 days of invoke date.We reserve theL right to assess 1.5% <br /> finance charge per month-on past due accounts.Customer assumes full responsibility for all rented items,Including sale <br /> and proper use,operation, routine maintenance,and storage.Customer is responsible for all loss,damage or repair. <br /> WHITE•CLIENT YELL(YN•JCB FILE GREEN-ACCOUNTING GOLDENROD-DISPATCH <br />