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Billable <br /> SERVICE REPORT I--] Factory arr. <br /> wt-raoctuaMAYNTEn►wrrce1-1 Maintenance <br /> rnes ,cACDof Billable <br /> (559) •1730 Fax:(559) -1735 3687 N.Valentine Ave. Fresno,CA 93722 fr License No.779267 ' Jo <br /> Please Visit Our Website: www.lcservices.com <br /> Name: J e <br /> Service <br /> Address: Date: <br /> City: 5 1 Zip: Phone: <br /> Work Order# <br /> Dispenser Make <br /> Cust.Order# <br /> Dispenser Model: <br /> Close Conrar. <br /> Dispenser Serial : <br /> Parts Order# <br /> Pump Test: Gallons: Dollar Amt: <br /> ascription Of Work Performed <br /> ATE C LTE "-(— I, give authori"LCServic <br /> bt0a9Ab° ® � boat b dbeaitrd Print Name <br /> to run my credit card as form of payment. <br /> iSha bta <br /> Mm MYW Wilk 6bN(�r aF .Vrea aaMbyaaaaap Ire r�fitbdei:p anasace�ib <br /> b W ITOW fti Qb4gim bay opwat Card Type: Card#: Billing Zip: <br /> I3 Ci by ow Is axamy,wn ww wr4sen bYw afte,ayoa as9wis,b am,Iyeeam Exp Date:! / Security Code: <br /> w0i'li Old 0 Mwdng drAw Is opuft,a inasup aeytoM 0wMard .bw <br /> by law,Va Uft Name on Card: <br /> (EG I�e6yexpeesAr a@war <br /> � � � d cepa" ,end❑eaha ee!aa� say b <br /> Work Authorized by Date <br /> m <br /> Oty Part No. Inv. Descrltion&S/NEach Amount <br /> Loc# <br /> Worker Date De artArrive' De art Stop O!T <br /> r Total Labor <br /> Total Parts <br /> Mileage <br /> Travel <br /> Sales Tax <br /> i Total Amount <br />