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Headquarters: 4895 S. Airport Way, Stockton, CA 95206 <br /> Mail to: P.O. Box 1107, Stockton, CA 95201-1107 <br /> VAN DE POL Orders & Billing: (800) 736-3421 Fax: (209) 466-1910 <br /> DELIVERY INVOICE <br /> 143402 <br /> TOLD I f) DATE/TIME �'Z AM <br /> PM <br /> STREET <br /> ADDRESS �i..�. DRIVERMIHSE -0 <br /> CITY DELIVER TO <br /> &STATE <br /> P.O. <br /> ❑Charge ❑Cash ❑Credit Card RECEIPT/CHECK# NUMBER <br /> SUPPLIER SUPPLY BILL OF LADING PRODUCT QUANTITY UNIT AMOUNT <br /> POINT NUMBER DELIVERED PRICE <br /> UNLEADED GASOLINE GASOLINE,3,UN 1203,PG II <br /> MID-GRADE GASOLINE GASOLINE,3,UN 1203,PG II <br /> UNLEADED PREMIUM GASOLINE GASOLINE,3,UN 1203,PG II <br /> CARB DIESEL#2 DIESEL FUEL,3,NA 1993,PG III <br /> THIS DIESEL FUEL DOES NOT CONTAIN VISIBLE EVIDENCE OF DYE. <br /> i <br /> CARB DIESEL#2(RED DYED) DIESEL FUEL,3,NA 1993,PG III <br /> THIS PRODUCT IS DYED DIESEL FUEL.NON-TAXABLE USE ONLY. <br /> PENALTY FOR TAXABLE USE. <br /> KEROSENE KEROSENE,3,NA 1223,PG III <br /> PRODUCT CODES OTHER PRODUCTS QTY. PKG. UNIT PRICE AMOUNT <br /> ,G <br /> QUANTITY ' <br /> CA.MOTOR OIL ASSESSMENT FEE(PER GALLON) <br /> CA.OIL RECYCLING FEE( PER GALLON PER LB.) <br /> FEDERAL EXCISE TAX <br /> STATE SALES TAX <br /> STATE USE FUEL TAX <br /> PREPAID TAX(SG KHE 78-005208)GASOLINE <br /> PREPAID TAX(SG KHE 78-005208)DIESEL <br /> i <br /> DRUM RECYCLING SURCHARGE <br /> FREIGHT <br /> (SUBJECT TO CORRECTION OF CLERICAL ERRORS) INVOICE TOTAL <br /> TERMS:AS ARRANGED OR NET 15 DAYS FROM DELIVERY DATE <br /> The purchase price is due and payable upon receipt of invoice and payable as DISCOUNT AMOUNT IF PAID BY <br /> shown under the terms of invoice,and unless paid by that due date,any unpaid balance shall be delinquent and subject to Net Invoice <br /> a finance charge applying a periodic rate of 1.5%.The ANNUAL PERCENTAGE RATE IS 18%.The finance charge stated after Discount <br /> herein is a charge for the credit sale of the goods purchased. It is part of the purchase price when such purchase price is METER/STICK READINGS <br /> paid for over time rather than when due. Delinquent accounts are costly to the seller to process and carry. The finance <br /> charge is an amount which both seller and purchaser agree represents a reasonable attempt to estimate a fair average PRODUCT BEFORE AFTER <br /> compensation to the seller for such expense.The buyer and seller agree to presume that the finance charge is equal to the <br /> seller's expenses of processing and carrying a delinquent account and they agree that it would be impractical,or extremely <br /> difficult to fix the actual expenses. <br /> PRODUCTS RECEIVED AND TERMS ACCEPTED BY: PRINT NAME <br /> X <br />