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RRIDGESTHBE 0055186 <br /> =M_ar_rio_t_fUr—,v­e or w lZqR - <br /> Nashville, TN 37214 ',-800-555-'2!z <br /> NATIONAL FLEET DELIVERY RECEIPT <br /> All required information must be provided in order to nave this receipt oro(eiseo Pe:.e,% 41ec- 171us and obtarrl billing equirements or to del-very <br /> • Mori, <br /> Fleet Account <br /> Name 1 <br /> Address: <br /> City,State,Zia L <br /> Phone. <br /> Fax: <br /> Alternate Fleet Narre <br /> Location Code. <br /> Purchase Order Numbe, <br /> Fleet Authorization# <br /> C._rrlperly_0 <br /> Telephone Number <br /> — <br /> Vehicle 0 <br /> Trailer I <br /> Wheel Position <br /> License Plate&ST Tq ------ <br /> COMMENTS (Special notes and DOT info) TAX DELIVERY INFORMATION <br /> BRIDGESTONE PRODUCT SOLD FIRESTONE/oTHER NEW TIRES and BANDAG RETREADS <br /> Qty Article Desrription Size Tread and ply7. <br /> Qtv DC�5�nollor, Size Tr,�Mrl.a7d Ply CT <br /> I L <br /> OURLY SERVICES (Emergency Road or Yard) ROLL IN ONLY(Do not charge when road service is performed) <br /> TIME OUT AVI,PI`,4 IN S—v;ce Pa,l Lan�-�r Desr­:�,. <br /> TIME 0" <br /> AV,PM IN <br /> M <br /> Service Hours Min 'in-t Price <br /> ROAD SVC REG M-;TEI <br /> ROAD SVC OVERTIME M-F TB <br /> ROAD SVC SATISUNIHOL TB <br /> YARD LABOR REG HOURS <br /> LA <br /> YARD LABOR WAFTER HOURS <br /> YARD LABOR SAT6UN/HCL OTHER/COMPETITIVE BRANDS(New/Used/Retread) <br /> F_ ItY a 0 Descr-pt,on S -'ean and <br /> CASINGS <br /> 777 Unit Prir.eFleet App,c,.,�,, <br /> !-PRINT RECEIVER NAME SIGNATURE OF RECEIVER <br /> F.f <br />