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SUBMIT PAYMENT TO: INVOICE NO. 3063 <br /> 1'ITE <br /> ON-SITE TECHNOLOGIES '776Customer Service D�1715S Bascom Avenue -2' L <br /> Work Order No <br /> TECHNOLOGIES � 71ya�gsooa +3s equested Date <br /> Requested By <br /> Billing Atter: 174�95 ., J• �. �OZ Site Contact: <br /> Company i Company: <br /> Street_ Street: <br /> City- S tate City- SZ24, 232. 7 State <br /> Zip Phone: Zip Phone <br /> Model Name/Number- ! Serial Number: <br /> I <br /> Reported Problem. ��E/�'Ly S'��� J Code: <br /> Problem(s)Found. <br /> 1 <br />' Work Done To Complete Problem(s): ! W GD <br /> .a <br /> Ic <br /> O i L <br /> Lfz _._.. <br /> Nates or Recommendations: 4 'r— Z6 " tz/e— <br /> 1[ E4-4 Aa Cue_ <br /> It it &,.,C <br /> It Ir r` get <br /> - <br /> r /r . 2 [G/ 4 <br /> 1 f / • S • k Gc! <br />' Quantity Parc Number Desc spoon L st Pace Total <br /> I <br /> I I I <br /> Work Performed By: r tate: 1 7 <br /> Work Authormaaon: Charges: <br />' Signature: Sate Vlanager/OperaEovOwner Torsi Parts Cast:S <br /> Work Performed Acknowledgement: 7-,p flours tabor @ per hats S <br /> 12 C2 mites travel @ per mile S <br /> ature: �►uthorszed Sernce Rep_ <br /> ��c7 hours travel @ per hotr S <br /> Signature: Sate Manager/Operatar/Owner Total Charges S <br />' Whrte Customer Yellow- File Pink- Regulator Goldenrod- Sencce Rep <br />