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3887 N.Valentine Ave.* Fresno,CA 93722 t(559)444-7730 � Billable <br /> License No.779267*AN EMPLOYEE OWNED COMPANY K--1 Factory 'Warr, <br /> ' ® Please Visit Our Website: www.[cservices.com L—J COD <br /> PETROLEUM MAINTENANCE CO, <br /> � Not Billable <br /> E FRESNO,CA 1= Bid J o b <br /> Name: <br /> SR 11TH 128000 - <br /> Service <br /> Address: Date: <br /> City; Zip: Phone: Work Order 9 <br /> Dispenser Make �; <br /> p e cuss.P.o# _!� <br /> Dispenser Modef: ,[1 __ _ Close contir.# <br /> Dispenser Serial ##: PurchaseOrder# <br /> Pump Test: Gallons: Dollar Amt:_/j <br /> Dy scription of Work Performed <br /> /12 <br /> 1, give authorization to LC Services <br /> �I�lla$llre $c Date Print Name <br /> . to run my credit card as form of payment. <br /> Ihre will be rasponsibls 1w a 475.Opbookkaapl ea if my raccounl is assigned Im a Prod pally Iw oollacfions.Should sill be wnvnanrxd <br /> to enlorce arty of the lamrs d bds agreemen pe+ral' pally diel ha enblled lo reasonable allorneysfees and the Coud orjurisdnlion Card • <br /> shall he in(your ooumry).Promw Cormly we ha gram io you crony assrgnee the fight to verify empbymenlwnararreBEraporlb <br /> assess erylour ablAf to I051 mylw finer© rgalion to IhisagreemmL <br /> Card Type: Billing Zip: <br /> Ir communlna m by phone is necessary,pwe gram pamisaion to rw oNke.or your assigns,to anlactmslus by pbsme.R gwe are <br /> unavailable,ands rexiehg dews is operable,amassage may ba tell providing aroma andphonanum&i. EXp Date: 3 Digit Seen rity Code: <br /> VmEesso grMse providing by law,Ihaseller(LC Service.)hmbycapressly6wlaims all wanantles,eiltrer expmssadw implied,indud'nu lame on Card: <br /> arty Lnp]ied w�ranly d merchaniabiiily W fitness Iw a pedicular puposa,and nai9�er assumes nw aulhorkes any other parson b assume [. <br /> for kl aay6ebliiyinmmemfan wiEh Ne salaMsaid products Work Authorized by Date <br /> Signature <br /> Qty Part No. Inv. Description & SIN Each Amount <br /> LOc# <br /> Worker Date Depart Arrive I Depart Stop O/T <br /> Total Labor <br /> Total Parts <br /> Mileage <br /> Travel <br /> Freight <br /> Sales Tax <br /> Total Amount <br />