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3887 N.Valentine Ave.* Fresno, *( )4"1730 E= Billable <br /> CA 93722 559 License No.719267 1r AN EMPLOYEE OWNED COMPANY E:3 Factory Warr. <br /> C= COD <br /> SEI OLfuMA�INTEN�tNCEcp PleaseYlslt Our Wsbrite' www Icesrvicfs tom � Not Billable <br /> �RFsrvo,ct M Bid Job <br /> Name <br /> 5 /4 Sit N° 137979 <br /> Service 3 Z <br /> Addres/sN.�,,` We <br /> City '`' Zip Phone. M,order s <br /> Dispenser Make Cusl P a 6 <br /> Dispenser Model. class coanr <br /> Dispenser Serial#. PumhmOreer1 <br /> Pump Test. Gallons Dollar Amt. <br /> Description of NVork Performed <br /> L -6a LP Sri t > CIA e <br /> I, give authorization to LC Services <br /> Signature & Dat Pant Name <br /> to run my credit card as form or payment. <br /> v.e r M et6ow_�ft rr i I M C4 Cwuel Ir f l+lrr etvm a w"e e•.e pr Ir whawe WW ll M mew�1 <br /> e&w""21 re d eM 07%l P.Pt Pill rat Ee wm d k;Am wa rrlil we rd htaa dwell Card#' <br /> My to r tow wo4ti s f MM C lf" V1 b w!F GrOmof er a c+af 11) <br /> Am!c-"rar,b to-"0 14911hoa t M Will <br /> Card Type: Bitlirtg 7Jp: <br /> 1 CCAA .AVO h"a UMWY Y.e pn n l dka a eue ar7r.a mad am pf d*•r p v e w <br /> ".,L"„reExp Date:�l�! 3 Digh Security Code: <br /> LOW d4l.a! ,p+e h cll�ilc Sr+nei►reor oPt►th'Asar a d7,rryrq all two""lad.a mu" Name on Card: <br /> r!.t}d�+T!tl�alnarret,d Irrr IQ a Incur pep�r ero roe!ir atn�u�w,fat�n r7 ohr f4�p eliunl <br /> brInmwrPmnrmwreMdNopll Work Authorized by Date <br /> 51rjnature <br /> A 3%CONVENIENCE FEE WILL BE APPLIED TO ALL CREDIT CARD TRANSACTIONS <br /> Qty fart No. Inv. Description & S/N Each Amount <br /> Loc# <br /> EVorker D to Depart Arrive Depart Stop O/T <br /> CJa f Total Labor <br /> Total Parts <br /> Mileage <br /> Travel <br /> Freight <br /> Sales Tax <br /> Total Amount <br />