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FILE <br /> .l REMIT T0: k> <br /> PO Bo)C910530•Denver,CO 80291-0530 <br /> INVOICE DATE COST.NO, ORDER NO. PAGE INVOICE NO. <br /> TIRES&SERVICE 0571271 194845 40126 1 855-37293 <br /> GCR 350325 STOCKT C855TTC <br /> 4336 POCK LANE, SUITE 200 <br /> STOCKTON, CA 95206 <br /> (209)983-9495 Tax Id: Stockton CA 95206 US <br /> SOLD CIRCLE TRANSPORT INC SHIP SIERRA CHEMICAL <br /> TO 315 FIFTH STREET TO <br /> PERU, IL 61354-2859 <br /> PURCHASE ORDER NO, SALES PERSON PHONE SHIP VIA <br /> A378 4099 209-983-8299 DELIVER <br /> ITEM NO. DESCRIPTION OTY.ORDERED QTY,SHIPPED F.E.T. PRICE NET EXTENSION <br /> *YG# A378 LRO ISIDEWALL DAMAGE] <br /> 354BDMS BD LP 22.5 BDM STOCK 1 1 0.00 201.51 201.51 <br /> 354 CS LP 22.5 RDL CASING-GRADE A 1 1 0.00 110.00 110.00 <br /> VSTK SV VALVE STEM - TRUCK 1 1 4.25 4.25 <br /> TD SCRAP DISPOSAL CHARGE 1 1 12.00 12.00 <br /> HRTKE EMERGENCY REG HOURS SERVICE CALL 1.00 1.00 93.00 93.00 <br /> TPID# 1099876-0 (TDS#) <br /> CHK'D BY: DELV'D Bl(: <br /> otal Uni s: 5 <br /> Charge: 450.26 Sub T t Parts: 327.76 <br /> Sub t Labor:1 93.00 <br /> Ez=1.JJ=c o perform the above written services to their vehicle. bales ax <br /> SEE INFORMATION STATEMENT OF REVERSE SIDE REGARDING CONSUMER CREDIT CONTRACT AND SECURITY AGREEMENT <br /> X <br /> PRINT NAME/AUTHORIZED SIGNATURE <br /> NOTE! In order to save all FINANCE CHARGES,the customer must pay,in full,the entire unpaid balance by the 10th of the following <br /> month.FINANCE CHARGES are computed on amounts 30 days or more past dun at the PERIODIC RATE of 1.5%PER MONTH Inv Total 450.26 <br /> (MINIMUM CHARGE OF$1.00)which Is an ANNUAL PERCENTAGE RATE OF 18%.The above credit terms have been sat out <br /> in accord with the TnIIh-In-Lending requirements of the Federal Government and are for the customers benef t and protection. <br /> PAY FROM THIS INVOICE <br /> PO# <br /> Date Delivered: Disposition of Take Off Tires: Your wheel components have been inspected <br /> Fleet Authorization# _Ret'd w/Driver _Ret'd w/Dealer and it has been determined your wheel components <br /> Credit Release# _Ret'd to Customer _Ret'd for Warranty require immediate attention. <br /> Phone: <br /> Customer/Fleet Acct# Tire Replacement Reason <br /> Customer/Fleet Loc# � A wheel assembly has been installed. Industry <br /> guidelines require that the torque level of the <br /> wheel nuts be rechecked between 50 and 100 <br /> Vehicle Information: For ERS Information Only: miles of operation and retorqued as necessary. <br /> Hubometer ERS Work Order# Failure to do so may result in loss of this assembly. <br /> Make Odometer DOT On Tires I acknowledge receipt of wheel assembly info. <br /> Model Color DOT Off Tires <br /> Vehicle# Lic#/State <br /> Trailer# Chassis# Driver Roll Time <br /> Tire/Wheel Pos: (Signature) <br /> Container# SeriaWIN# <br /> (Name Printed) <br /> FILE <br />