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FILE <br /> .. REMIT T0: p0 Box 910530 Denver,CO 81 0530 <br /> 029 <br /> INVOICE DATE COST.NO. ORDER N0. 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 C h at r-9 e <br /> 7A 4099 209-983-829 DELIVER <br /> ITEM NO. DESCRIPTION CITY.ORDERED QTY.SHIPPED F.E.T. PRICE NET EXTENSION <br /> 2 0.00 139.77 279.54 <br /> TD SCRAP DISPOSAL CHARGE 2 2 8.00 16.00 <br /> HRTK SV HOURLY RATE - TRUCK 1.00 1.00 93.00 93.00 <br /> 422 CS 1IR24.5 RDL CASING-GRADE A 2 2 0.00 110.00 220.00 <br /> *TRL 7A LIC-525269 ILL <br /> *RRI/O OFF TIRES AGED AND CRACKING <br /> TPID# 1099876-0 (TDS#) <br /> CHK'D BY• DELV'D B : <br /> otal Units: 7 <br /> SubT t Parts: 515.54 <br /> SubT t Labor: 93.00 <br /> Customer authorizes company to perform the above written services to their vehicle. <br /> SEE INFORMATION STATEMENT OF REVERSE SIDE REGARDING CONSUMER CREDIT CONTRACT AND SECURnY 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 50th of the following Inv Total 654.94 <br /> ' month.FINANCE CHARGES are computed on amounts 30 days or more past due at the PERIODIC RATE of f.S%PER MONTH <br /> {MINIMUM CHARGE OF$5.00)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 customers benefit and protection. <br /> PAY FROM THIS INVOICE <br /> PO# <br /> Date Delivered: Disposition of Take Off Tires: F---j 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# F-7 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 /> TireA,Vheel Pos: (Signature) <br /> Container# Serial/VIN# <br /> (Name Printed) <br /> FILE <br />