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QTY PART# DESCRIPTION AMOUNT IMO L.13 _3555+ <br /> t/il IR-` t_11=T TRUCKS,INC_ CONTACT PERSON: '4 a <br /> / S FORKLIFT SERVICE, SALES, RENTALS & PARTS CO ACT PERSON'S#: <br /> /� 395-5 E.Wetmore Street,Manteca,California 95337 <br /> ' ',c5A- A:e / K MAfft Office3(868)456-0694-Fax#(209)249-5454 <br /> A{jt� �V l Jf� WWW.GOLDCOASTLIFTTRUCKS.COM <br /> r� <br /> Name - Date f z_/_3 -1 7 TROUBLE REPORTED ev CUsroR: <br /> Address t4q..I'Al Df OdW -plKW z. P.O.# <br /> City Phone ��9 l r <br /> Make Model �G" x, HOURS- <br /> I.D. <br /> SIN f L-07 I.D. J Mechanic�,,I� (�',r Z t <br /> DESCRIPTION <br /> QA 144- <br /> n <br /> cf 1cCf � i�c f, �� )�; t f�trinccQE <br /> r QfJ f• lU 5 PiC C <br /> 4. C. +Lg) <br /> re <br /> C. <br /> 1n; .S _. �.C... . H <br /> .- LABOR <br /> PARTS <br /> 3':.1 fir.• 6 � / '�. <br /> •'! r ! ! I <br /> 4- f1✓' L., -, ,�� FREIGHT <br /> I(buyer)hereby authorize the above repair work to be done along with the necessary material and hereby grant <br /> you (seller)and your employees permission to operate the equipment herein described on streets,highways or OUTSIDE <br /> elsewhere for the purpose of testing andkw inspection. I also acknowledge that ar parts, equipment attach- LABOR <br /> menta and/or equipment purchased remains in the salters title unill paid in futi.Seller has the right to reclaim all <br /> Parts, equipment attachments endfor equipment said, It buyer does not pay for them within the senate terms <br /> stated on invoices. Buyer Is to pay sets reasonable collection costs and tees, Including but not IimPoed to <br /> attorney's fees. <br /> `� TAX <br /> dr <br /> Work Auorined by signaturey <br /> Please Print Full Name and TPoe w k'": s�o `=_ : P �.� TOTAL <br />