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I CA.hJ <br /> Modesto Bottled Water Inc <br /> 9(r9 3 3 72 <br /> Wdest d <br /> I Modesto CA 95352 Account# <br /> {209)527 6764 <br /> Charge Code <br /> 16845 <br /> Service Address Date —,�//( /0.13 <br /> �, I;AnYt 5e( Phone No z -39-R4yr <br /> 17? Route No _F 1) 9 <br /> M&AA4 2 Zip-2LJ�33 7 Equipment Type L8.1 RA -] ,, <br /> 8ill,ng AddresSSena]No 21f ?-. -�-- 3�(_, <br /> 3o-5, JJ Rental S !�it_Piar id l tt it`, <br /> /VW-k-4�ca _ Zip 9 S 317 Reference ) <br /> Horne Office Phone { ! Ref Phone <br /> Owner/Employer Phone <br /> Horne/Employer Address Zip <br /> S 5# 8ustness/Drimer's Lr_ No T <br /> i M' rri r,(ryG Ir •.»9raI!"Yirrr / fHmwycjazr n k r v <br /> ONU1Xh�t 1 /iUN1T �tIGF" AMOUNT�� <br /> •iff%sc..,7x..cS�, iI/rtil5s� ,a Q14yn5 <br /> TAXABLE SALES <br /> 4 <br /> Cups 42R 450 Styo <br /> BOTTLE DEFOWS <br /> Bayes Willes <br /> on rand Rm"Ied Sates Tax r <br /> TOTAL �Z <br /> EQUIP NO (SET) (PLA <br /> w <br /> Reined cheek Cash I 1 <br /> on�c�amt z fib <br /> ACCEPTANCE Equipment IPase <br /> I am the Cust r or authorized the Cus[omer Agreement Accepted IrvUal <br /> to accept t terms o regiment and Accept Modesto Bottled Water, Inc <br /> have rete ado s <br /> By signao-Ke By <br /> Tide Date Installed <br /> Rot N,mc <br /> .�,.,f OFFICE unirTF CLISTOAAER YFuow nCCCXJW VG PMA <br />