Laserfiche WebLink
VVV1 • VI\1 1\L.\►11_11 1 <br /> North American Fleet Accounts/Government/Public Utility <br /> Truck•Agriculture-EarthMover•Light Truck&Passenger Tires.Retreading,Repairs,&Services. <br /> MICHELIN NORTH AMERICA,INC. - P.O.BOX 19007,GREENVILLE,SC 29602-9007 <br /> DEALER SHIP TO NO. 1 flAill-V <br /> .- <br /> 6 e �i � 0 3 cs' DR 65473 : <br /> Name <br /> reet A ess(D Not se P.O.Box No.) City State Zip Code Street Address(Oo Not Use P.O.Box No.) City State Zip Code <br /> Fleet Localion Purchasing Tires/Service Fleet Headquarters orParent Company <br /> -et Ship to Number gam'(e `/. <br /> Name F <br /> Lc5 <br /> :et/T irminal Location Number Street Ad ress,(Do Not Use P. .Box N•.) City State Zip Code Ci state Zip Cot <br /> 4 <br /> 45 . �4 A Tia � U -coo_�.-t,��i �f 5.�u� S u�,I� ' Q uip <br /> 'ORTANT Sales Tax-Please 1. Tires/Service delivered at2. Tirei/Service provided at . Road Service'Tires/Service at State Zip Code ONCa I I' Case Number <br /> A Indicate Check One Only(✓)�® Fleet Terminal location ❑ Dealer location � other location.Must provide ST&Zip <br /> •• - -16 �lefiLej. fall I'll • I Government Reet/Credit Card Fleet Member <br /> Guarantee Price No.: Member Name: Card No.: <br /> alit Exp.DateVehicle) Vehicle Description/ License No. <br /> rdNo.: Unit No.: Make&Model: &ST: <br /> h.IDNIN Odometer Release Division Michelin Credit Approval <br /> Reading: No.: Branch/Agency Toll Free:888-358-4731 <br /> rchase -� —1 / Coupon PO/Coupon Tel <br /> yen No.&Dated ID: Authorized By: No.: <br /> FY MSPN Related ComrN�tete Descri tton Unit DOT/Tire Serial No. wheel Tire Tom' DOT/Tire Serial No. Reason For <br /> ProducVSe"� MSPN nra size/T.ead Design Ra p Price New/Retread Tire(s) RMSPNd Tim <br /> ete LDescription � New/Retread Tire(s) Removal <br /> Code a Range/veni�ie se"rce Pos. Dapm <br /> LTa45; %( tj _S R1$ <br /> So-31 q - zD <br /> IMPORTANT.Fleet employee must print and sign. Th gyve been➢urchased for our own use and not for sale. <br /> 1 Mandatory , /,S"i ;ture Mandatory <br /> Naxn l y-) 6! / L-�-�C 1 I(11�!G 1 l_ Signature - C�f -=t Ir <br /> !Nre <br /> tame He <br /> MNA 2044)05(Rev.12/04) Item No.MIE40220 <br />