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P1 CA-) <br /> Modesto Bottled Water Inc <br /> B,,,4643 <br /> M <br /> Modesto CA 95357 Account# 2_ a <br /> f209J 527-6764 ' <br /> Charge Code <br /> 16737 <br /> Service Address Dam ! I 1 1 <br /> - �- — Phone No Z 3`i- (o <br /> jl <br /> -3:.79 Y-U S A Route No U �70 <br /> 1"k?(xn+C C Z)p 9y 3_3 7 Equipment T <br /> Billing Address }_^ r n J Serial No �- <br /> 3 U"S _ Rental I --- .._Per <br /> { fq/Ja eCe�, Zip 7 R,f,,rre <br /> Home Office Phone i J Rer Phone <br /> I <br /> Owner/Employer Phone <br /> Hon--e/Employer Address ZIP <br /> ' S S# SUSrneSS/Dnwr's LIc No <br /> r � <br /> au <br /> �J�II�PRIC Ate Nt <br /> �,�, <br /> TAXABLE SALES <br /> i <br /> CLIPS 42R 450 Sty* <br /> BOTTLE DEPOSITS —� Chi Cn/ <br /> Boma BotUez <br /> on Hard Renxned Sales TGIF <br /> TOTAL, 3 Z <br /> EOUIPNO (SETS (puI - <br /> z <br /> Reomtd Check Cash I <br /> mAaaunt z_ M1b I <br /> Equipment lease <br /> 1 am the Cus r ora d by the Customer Agreement Accepted Irrt,al <br /> to accep e terms his mens and <br /> have rec d a items Accep d odest0 Bottleq�Wa[Cr,'M[, . <br /> � By , <br /> �m� <br /> Title rfinl Mare Date Installed 2Iq",O- <br /> nrw OFFICE WFGTE CUSTOMER YEllDW ACCMIJ71�P11. <br /> AArRft4)W RV71S71 7117 <br />