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0 Billable <br /> 0 SVC No: 6923 0 A <br /> a / <br /> DATE HNIC : o WSE <br /> Q other <br /> 4688 W.Jennifer Ave.,#101 <br /> �es* IA�K <br /> TM Fresno, CA 93722-6418 <br /> perjoMaIWIPMEW (559)276-5410 I Fax 559.277-0106 <br /> N NAME OF SI ®f, BILLING NAME: <br /> e <br /> ADDRESS: ADDRESS: 1007 CONTACT: <br /> SITE PHONE NO: BILLING PHONE NO: CUSTOMER POS <br /> S£RIAL NO.: INSTALL DATE: CORRECTIVE ACTION TAKEN: <br /> O <br /> O <br /> N NT tA <br /> EQUIPMENT SERVICED: SERIAL NO.: INSTALL DATE: I CORRECTIVE ACTION TAKEN: <br /> COMPLAINT <br /> PART NO. DESCRIPTION SERIAL NO. ;>:::``f ' r:?l4=i'M_:.. . . ALLL <br /> . .''..,;: <br /> 4ra. <br /> ... ..,..r.:..._... :. <br /> Y 7 <br /> ...... .....: <br /> UL ,.a <br /> In St <br /> N : <br /> O <br /> CK} t x. <br /> N -c: <br /> ' <br /> O t TW LL AM CEJE <br /> s <br /> M 1 dearly understand and agree that all services are charged directly to me and that I am personally responsible for payment. I understand that if I <br /> suspend or terminate work,all fees for services wilt be immediately due and payathe event of my default of payment,I promise to pay legal interest on the indebtedness <br /> UtU together with such collection costs and reasonable attorney f as4mayuiyeffect (lection. ` <br /> ® DATE CUSTOMER'S SIGNATURE PRINT NAME p P' <br />