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r � <br /> SERVICE/REPAIR AUTHORIZATION <br /> A M lEjfflMllr <br /> CALIFORNIA CONTRACTOR LICENSE 309105 C-41,9A <br /> 808-820 N.UNION ST.STOCKTON,CALIF.95205P.O.BOX 508 <br /> PHONE 209/484-BJOJTON.CALIF.95201 <br /> N�EN�P�Q�ICES. <br /> SALES . SERVICE . INSTALLATION OF PETROLEUM DISPENSING . LUBRICATION&INDUSTRIAL SERVICE EQUIPMENT <br /> P.O.# DATE M 1 <br /> AUTHORIZING NAME COMPANY NAME - <br /> BUSINESS ADDRESS ST. <br /> LOCATION <br /> CITY 1. ZIP PHONE <br /> AUTHORIZED REPAIR OF THE FOLLOWING EQUIPMENT <br /> J <br /> r- \ \ Q�Q <br /> --- I HEREBY AUTHORIZE THE REPAIR,SERVICE WORK TO BE DONE BY STOCKTON SERVICE STATION EQUIPMENT COMPANY <br /> INC.AS DESCRIBED ABOVE ON THE EQUIPMENT NAMED HEREON.ALL REPAIR PARTS ARE TO BE BILLED AT S.S.S.E. <br /> REGULAR PRICES.1 AGREE TO PAY CASH FOR SUCH REPAIR PARTS AND LABOR ON DELIVERY OF EQUIPMENT OR ON <br /> TERMS SATISFACTORY TO S.S.S.E.AND UNTIL PAID IN FULL ANY UNPAID BALANCES SHALL CONSTITUTE A LIEN ON THIS <br /> EOUIPMENT.I FURTHER AGREE THAT S.S.S.E.WILL NOT BE HELD RESPONSIBLE FOR LOSS OR DAMAGE TO SAID <br /> EQUIPMENT FROM FIRE,THEFT OR OTHER CAUSES BEYOND S.S.S.E'S CONTROL <br /> I AGREE TO BE INVOICED AND WILL BE SUBJECT TO TERM. <br /> A�iTHO�IZ SIGNATURE �j� TITLE <br /> y X / . <br /> FORM#0015 [/ <br /> CUSTOMER COPY <br />