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FILE <br /> c <br /> REMIT T0: � PO Box 910530•Denver,CO 80291-0530 <br /> INVOICE DATE CUST.NO. ORDER NO. I PAGE INVOICE NO. <br /> TIRES&SERVICE 07/02/14 19484 32382 1 1 855-29981 <br /> GCR 350325 STOCKT C855TTC <br /> 4336 POCK LANE, SUITE 200 cc3pv <br /> STOCKTON, CA 95206 <br /> (209)983-9495 - <br /> SOLD SHIP <br /> To CIRCLE TRANSPORT INC TO SERBIA CHEMICAL <br /> 315 FIFTH STREET <br /> PERU, IL 61354-2859 <br /> PURCHASE ORDER NO. SALES PERSON PHONE SHIP VLA <br /> C1-z a r g e <br /> ITEM NO. DESCRIPTION CITY.ORDERED CITY.SHIPPED F.E.T. PRICE NET EXTENSION <br /> *TRLR 445 2LO <br /> *BACK OF SHOP <br /> 422FTRS BD 11R24.5 FCR TRAILER STOCK 1 10.0 140. 1 140. 14 <br /> 422 CS 11R24.5 RDL CASING-GRADE A 1 1 0.0 120.0 120.00 <br /> HRTKE EMERGENCY REG HOURS SERVICE CALL 1.012 1.00 95.512 95.50 <br /> VSTK SV VALVE STEM - TRUCK 1 1 7.212 7.23 <br /> AL V2B INFLATE THRU CAP (ALLIGATOR) 1 1 1.51.50 <br /> TD SCRAP DISPOSAL CHARGE 1 1 10.02 10.00 <br /> *OFF TIRE SEPERATED <br /> TPID# 1099876-01 (TDS#) <br /> CHK'D BY: DELV'D <br /> Total Units: 6 <br /> Charge: 374.37 Subof Parts: 278. 87 <br /> Sub of Labor: 5 <br /> Cu �+r ei FMC <br /> ysAys)o perform the above written services to their vehicle. <br /> SE F R A T•f 5 ATEA M OF REVERSE SIDE REGARDING CONSUMER CREDIT CONTRACT AND SECURUY AGREEMENT <br /> X <br /> PRINT NAME/AUTHORIZED SIGNATURE <br /> NOTE: Ic order to save all FINANCE CHARGES,the customer must pay,in fall,the entire unpaid balance by the 10th 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 Inv Total 3774.37 <br /> in accord with the Truth-In-Lending requirements of the Federal Government and are for the customers benefit and protection. <br /> PAY FROM THIS INVOICE <br /> PO# <br /> Date Delivered: Disposition of Take Off Tires: O 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 A wheel assembly has been installed. Industry <br /> Customer/Fleet Loc# <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# Serial/VIN# <br /> (Name Printed) <br /> FILE <br />