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Q FILE <br /> r <br /> REMIT T0: PO Box 910530•Denver,CO 80291-0530 <br /> INVOICE DATE COST.NO. ORDER NO. PAGE INVOICE NO. <br /> TIRES&SERVICE — <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 CHEMICALS <br /> TO 315 FIFTH STREET TO <br /> PERU, IL 61354-2859 <br /> PURCHASE ORDER NO, SALES PERSON PHONE SHIP VIA <br /> C. <br /> 4099 209-983-82gq DELIVER <br /> ITEM NO. DESCRIPTION QTY.ORDERED QTY.SHIPPED F.E.T. PRICE NET EXTENSION <br /> 354FTRS BD LP 22.5 FCR TRAILER STOCK i 1 0.00 134.81 134.81 <br /> *TRLR 34 LF0 ESIDEWALL CUT] <br /> 354 CS LP 22.5 RDL CASING-GRADE A 1 1 0.00 110.00 110.00 <br /> HRTKE EMERGENCY REG HOURS SERVICE CALL 1.00 1.00 93.00 93.00 <br /> VSTK 5V VALVE STEM - TRUCK 1 1 7.00 7.00 <br /> TD SCRAP DISPOSAL CHARGE 1 1 8.00 8.00 <br /> *LIC# 525271/ILLINOIS <br /> TPID# 1099876-0 (TDS#) <br /> CHK'D BY: DELV'D B : <br /> otal Uni s: 5 <br /> SubT t Parts: 259.81 <br /> SubT t Labor: 93.00 <br /> Net loth Prom f-ale5 TaX., 23.38 <br /> Cus•.omer authorizes company to perform the above written services to their vehicle. <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 Inv Total 376. 19 <br /> month.FINANCE CHARGES aro computed on amounts 30 days or more past due at the PERIODIC RAPE of 1.5%PER MONTH <br /> (MINIMUM CHARGE OF$1.00)which is an ANNUAL PERCENTAGE RATE OF 16%.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 /> 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 <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# Serlal/VIN# <br /> (Name Printed) <br /> FILE <br />