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'TanHarbot.-I <br /> VIRONNIENTAL SERVICEV <br /> INVOI E I AUTHORIZATION FOR CREDIT CARD BILLING <br /> Date: 51 9!2008 <br /> Job# 6J1891647 <br /> To: Clean Harbors Environmental Service ob#SA06 I <br /> 46 <br /> Fax: <br /> Phone: 781-792-5249 <br /> Account Number: <br /> From: Name: Telephone: 209-832-0200 <br /> ti/ <br /> pan : Bill Mower Saw <br /> Fax: <br /> n Address: Bills M wer and Saw Zip Code: 95304 <br /> State: Trac C <br /> This is authorization to pay the following Clean Harbors invoices: Amount <br /> Date <br /> Invoice Number <br /> Date Amount Invoice Number <br /> 5- -08 85.00 <br /> ___-- - <br /> 85.00_._______ <br /> Total Charges to be ppl�ed to credit card will be for the following amount: � CHECK <br /> AMERICAN EXPRESS INVOICE <br /> VISA MASTERCARDCHECK# <br /> PIN# <br /> _ No Yes <br /> if yes,what is the amount?- <br /> Name <br /> mount?Name as it appears on Card: BRUCE GLEN VINCENT <br /> Company Name: Bill Mower and Saw <br /> Gard Billing Address: <br /> 7834 West 11 St <br /> — Try Ca4,�� J <br /> Credit Card Number: <br /> Card Authorization D te: <br /> Authorization Signat re: <br /> U-S. MAIL <br /> RETURN RECEIPT BY: F <br />