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Billable <br /> SERVICE REPORT Factory Warr. <br /> Maintenance <br /> FuFs znrNA ca.CA of Billable <br /> Job <br /> (559) 1730 Fax:(559) •1735 * 3887 N.Valentine Ave.* Fresno,CA 93722 License No.779267 i <br /> Please Visit Our Website: www.icservices.com <br /> Name: <br /> Service <br /> Address: e- ®ate: `� "" <br /> City: -s I Zip: Phone: work Order <br /> Dispenser Make Cust.Order# <br /> Dispenser Model: Closecon8r.8 <br /> Dispenser Serial : Paris Order <br /> Pump Test: Gallons: Dollar Amt: <br /> Description of Work Performed <br /> e <br /> ATE COMPLETE i I, give authorization to LC Services <br /> Print Name <br /> w®WN be kraSn-w boAkeWN Ind msfFdpe 1w cahcfion.SONS betammmd to run my credit card as form of payment. <br /> ID otno a%aw tinn d M aFu=K N Wwaffiq p" be mWW la rmwWft aftmeft kes Olemoo}puddWn <br /> sAol°°nbo° ,aF esa� a w,+ " r.a "°�a'� °°�' a Card Type: Card : Billing Zip: <br /> b <br /> "C"MirkdoRby0as Ismemy,w wwpwmwm mss Wks.wy.naign,m=tis byPhm q r' ° Exp Date: / / Security Code: <br /> wwahw ow %opmWe,a 1e 4R a nave and phDw m bw. . <br /> Name on Card: <br /> biIn.w Sdff(Lc ells <br /> a Wr vd ummsfo r0wim""°dw Mm basume <br /> XNVorkAuthorized by Date <br /> Print Name <br /> Oty Part No. Inv. Description& SIN Each Amount <br /> Loc# <br /> �r r <br /> 23 <br /> b,6,31 <br /> J <br /> �5 G <br /> A <br /> rker `l Tate' Depart Arrive Depart stop O/T <br /> c Total Labor <br /> Ll (® Total Parts <br /> Mileage <br /> Travel <br /> Sales Tax <br /> Total Amount <br />