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rM I IGI W%poo. <br /> Arne.,ceW645dm Can ny o PAYMENT ONADODUINT <br /> , <br /> ❑CASH SALE <br /> (8001 77�7�43 ©CASH <br /> 10 al%WM SALERETURM <br /> ❑CREDIT MEMO <br /> AMUI"$ <br /> . j 6400 SPICULLTY elm= <br /> SACRAMMM, CA 95U9 <br /> ACCOUNTNUMBER UMBER ' J INVOICE P 7 21715 DATE /Z <br /> �( NUMBER <br /> I <br /> CUSTOMER <br /> NAME <br /> AND } <br /> ADDRESS l �� <br /> HOME PHONE WORKPHONE PO j r J( J <br /> NUMBER NUMBER I NUMBER <br /> COMMENTS <br /> TFW9S'C e E ti <br /> CYLINDER FILL ❑ 20 LB ❑ 30 LB ❑ 40 L.B P23B <br /> 1 Residential Customers All fees rates and charges are due within ten (10) dayss�uB Tots <br /> after the date of this Invoice at the office designated by The Company Delinquent <br /> accounts will be assessed a LATE PAYMENT CHARGE <br /> 2 Commercial Customers Charges shown are due In full by the "15th of the Month" `, QS Q <br /> following the date of this invoice Delinquent accounts will be assessed a LATE <br /> PAYMENT CHARGE # <br /> ADDITIONAL IMPORTANT TERMS AND CONDITIONS ARE USTED ON THE REVERSE SIDE OF THIS DOCUMENT <br /> CU MER S SIGNATURE(CHARGE SALES) DATEj� <br /> El GASHIMONEY ORDER�tr 1/4 �M k <br /> X w^ 1 / / D CHECK# JS1tfG <br /> MAN VER S APPR VAL SIGNAT RE(IF REWIRED) DATE $ D <br /> X t#w d'( 1 { ``rr� ElCREDIT CARD <br /> FORM NO ST 1019 S-3 (REV 7199) CUSTOMER <br />