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b FILE 0 <br /> ,. REMIT TO: ® PO Box 910530 Denver,CO 80291-0530, <br /> INVOICE DATE CUST,NO. ORDER NO. PAGE INVOICE NO. <br /> TIRES&SERVICE 03/20/1 194845 38136 1 855-35813 <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 /> 4099 209-983-8293 DELIVER <br /> REM NO. DESCRIPTION QTY,ORDERED CITY.SHIPPED F.E.T. PRICE NET EXTENSION <br /> *TRL# T83 LRIEFLAT SPOTTED] <br /> *BRING BACK DISPOSAL <br /> HRTKE EMERGENCY REG HOURS SERVICE CALL 1.50 1.50 93.00 139.50 <br /> TD SCRAP DISPOSAL CHARGE 10 10 12.00 120.00 <br /> *MOUNTED OUST. SPARE <br /> VSTK SV VALVE STEM - TRUCK 1 1 7.00 7.00 <br /> TPID# 1099876-0 (TDS#) <br /> CHK'D BY: DELV'D BY: <br /> otal Uni s: 13 <br /> Sub? t Parts: 127.00 <br /> SubT t Labor: 139.50 <br /> Cu dr a c m o perform the above written services to their vehicle. <br /> a t?s 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 70th 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 Inv Total , 277.93 <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-Inlending 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: 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# 0 <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 />