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FILE <br /> „ <br /> ri <br /> (REMIT T6 . N Box 910530•'Denver,CO 80291-0530 <br /> INVOICE DATE CUST.NO. ORDER NO. PAGE INVOICE NO. <br /> TIRES&SERVICE <br /> 07/20/15 194845 42092 1 855-39249 <br /> GCR 350325 STOCKT C855TTC <br /> 4336 POCK LANE, SUITE 200 COR 71 <br /> SOLD STOCKTON, CA 95206 SHIP <br /> TO (209)983-9495 1!iax Id: Stockton CA 95206 US <br /> CIRCLE TRANSPORT INC CIRCLE TRANSPORT <br /> 315 FIFTH STREET <br /> fL 61354-120-59 <br /> PURCHASE ORDER tJO. SALES PERSON PHONE SHIP VIA <br /> ITEM NO. DESCRIPTION OTY.ORDERED CITY.SHIPPED F.E.TG s PRL NET EXTENSION <br /> 4099 209-983-8298 DELIVER i^ <br /> 422BRXS BD 11R24.5 BRX STOCK 1 1 0.012 154.7t 154.75 <br /> *TRL# 345 RI [BLOWN] <br /> 422 CS 11R24.5 RDL CASING-GRADE A 1 1 0.012 110.012 110.00 <br /> HRTKE EMERGENCY REG HOURS SERVICE CALL 1.00 1.00 93.02 93.00 <br /> ACTKE SV TRCK AIR CHECK - FLEET PER UNIT 1.02 1.00 6.012 6.00 <br /> TD SCRAP DISPOSAL CHARGE 1 1 12.012 12.00 <br /> VSTK SV VALVE STEM - TRUCK 1 1 7.2 7.23 <br /> *LIC# 525-278/ILLINOIS <br /> TPID# 1@99a76-01 (TAS#) <br /> CNK'D BY• DELV s D Y <br /> Cu <br /> �}mer authorizes comggaa,��yy,,((oI��-orm the above written services to their vehicle. <br /> SE�tDN STA7�Id1 F REVERSE SIDE REGARDING CONSUMER CREDIT CONTRACT AND SECURITY AGREEMENT SubTot Parts: 283.98 <br /> SubTot Labor: 99.00 <br /> XNet 10th Prox Sales Tax: 25.56 <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 loth of the following <br /> ' month,FINANCE CHARGES are computed on amounts 30 days or more past due at the PERIODIC RATE of 1.5%PER MONTH <br /> (MINIMUM CHARGE OF$1.00)which is an ANNUAL PERCENTAGE RATE OF 18%.The above credit terms have been set out <br /> in accord with the Truth-In-Lending requirements of the Federal Government and are for the customer's benefit and protection. <br /> PAY FROM THIS INVOICE <br /> ADM rZA <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 Pas: (Signature) <br /> Container# Serial/VIN# <br /> (Name Printed) <br /> FILE <br />