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FILE <br /> REMiT T0: PO Box 910530+• Denver,CO 80291-0530 <br /> INVOICE DATE CUST.NO. 1 ORDER NO, PAGE INVOICE NO. <br /> TIRES&SERVICE 04/06/1 194845 39005 1 855-36321 <br /> GCR 350325 STOCKT C855TTC <br /> 4336 POCK LANE, SUITE 200 <br /> STOCKTON, CA 95206 <br /> (20.9)983-9495 Tax Id: Stockton CA 95206 US <br /> SOLD CIRCLE TRANSPORT INC SHIP SIERRA CHEMICAL <br /> TO 315 FIFTH STREET TO <br /> PERU, IL 61354-2859 <br /> PURCHASE ORDER NO. SALES PERSON PHONE SHIP VIA <br /> 9 <br /> 4099 209-983-82-99 DELIVER <br /> ITEM NO. DESCRIPTION CITY.ORDERED CITY,SHIPPED F.E.T. PRICE NET EXTENSION <br /> 388FTRS BD 1IR22.5 FCR TRAILER STOCK 2 2 0.00 134.81 269.62 <br /> *TRL# 1,7 RRI-0 [WORN] <br /> HRTKE EMERGENCY REG HOURS SERVICE CALL 1.50 1. 50 93.0 139.5@ <br /> TD SCRAP DISPOSAL CHARGE 2 2 12.00 24.00 <br /> VSTK SV VALVE STEM — TRUCK 2 2 7.00 14.00 <br /> 388 CS 11R22.5 RDL CASING—GRADE A 2 2 0.00 110.00 2220.00 <br /> *LIC# 525267 <br /> TPID# 1099876-0 (TDS#) <br /> CHK'D BY: DELVI D BY: <br /> Total Uni s: 10 <br /> Charge. 714.61 Sub of Parts: 527.62 <br /> Sub of Labor: 139.50 <br /> Net Imth Ppgx — Sales Tax: 47.49 <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 SECURITY AGREEMENT <br /> X PRINT NAME I 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 I n V Total 714.61 <br /> ' month.FINANCE CHARGES are computed on amounts 30 days cr more past due at the PERIODIC RATE of 1.5%PER MONTH <br /> (MINIMUM CHARGE OF S1.00)which is an ANNUAL PERCENTAGE RATE OF 18%.The above credit terns have been set out <br /> in accord with the Truth-In-Londing requirements of the Federal Govemment 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 f A wheel assembly has been installed. Industry <br /> Customer/Fleet Loc# L—J 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 (Signature) <br /> Tire/Wheel Pos: <br /> Container# Serlal/VIN# <br /> (Name Printed) <br /> FILE <br />