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3887 N.Valentine Ave.* Fresno,CA 93722 *(559)444.1730 � Billable <br /> 7PETROLELI <br /> License No.779267*AN EMPLOYEE OWNED COMPANY � Factory Warr. <br /> Please Visit Our Website: www.lcservices.com C��NTENANCE LO. � Not Billable <br /> FRESNO,CA , <br /> C Bid Job <br /> Name: <br /> Service SR N0 1378 1 <br /> Address: ' <br /> M\(�Q Date: <br /> City:-�� 411f� Zi Phone..- <br /> Work Order# <br /> Dispenser Make <br /> cust.P.0# <br /> Dispenser Model: <br /> Close confer.# <br /> Dispenser Serial#: <br /> Purchase Order# <br /> Pump Test: Gallons: Dollar Amt: <br /> Description of Work Performed <br /> rl OL f ✓r <br /> 1+ give authorization to LC Services <br /> reture & Date Print Name <br /> wwsiee aransmopoo oau na orrlmencetl to run my credit card as form of payment. <br /> dl Ne temsol Nis apreemurwnnyi wrlesrocoulrassyrlea me rgmmveny amlCard#: <br /> adlily m lulfill mylar flrlarcCard Type: Billing Zip:,nywr,enero na�mr,Iramwenn;:boamwerorcmeU.nywnoaeara�mirene,tameweaaa.ames=aaa may oa lanwrdm�awaaameam wlmr�e eemeer. Exp Date:_/_/ 3 Digit Security Code: <br /> unless mrami«wertl'mg cy lax,u�a«ue•0.c semceglcereeynyressry arsda'ans anxamanrns.mon vpressadw nngen,indWing Name on Card: <br /> a'ry LnWi N yarranb d mertllanUNl;Iy d rMess Iw a paNwiu puryose.atl nenner au woes rar amno'¢es am mom person m assure <br /> rorwanyaanw;y,n m,m yerl wim ma ssa al,a�a ponaols. <br /> Work Authorized by Date <br /> Signature <br /> A 3%CONVENIENCE FEE WILL BE APPLIED TO ALL CREDIT CARD TRANSACTIONS <br /> Qty Part No. Inv. Description & S/N Each Amount <br /> Loc# <br /> 00 Otilt ,eak(I <br /> v <br /> Worker Date Depart Arrive Depart Stop O/T <br /> C � /A <br /> 7 _ S` Total Labor <br /> ! Total Parts <br /> ;LCt - <br /> Mileage <br /> -S- ;� S- <br /> Travel <br /> 0-2 /� D Freight <br /> Sales Tax <br /> Total Amount <br />