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SEP-06-00 11 :02 AN FRF-":'S 2098257315 P. 03 <br /> (W <br /> Modestd Bottled Water,Inc. <br /> POdeSto, <br /> Modesto, 95352 account <br /> ii #� <br /> na wun wwr. <br /> (209).Q7-61764 <br /> Charge Code <br /> 97090 <br /> fService Address: Date <br /> Phone No. TO I I— <br /> I� 1'1-717 r w Route No. _ 10 <br /> f r zip Equipment TM N T USA. <br /> I <br /> Billing Address: Senal No. ,/ <br /> l� Rental S. ' Per Aw'k, <br /> Zip Reference <br /> Nome bffce Phone:l Rel.Phone <br /> t. <br /> Owner/Emplo)er: PhOne <br /> Home/Employer Address Zip <br /> Business/Driver's Lx.No, <br /> Arc- cr, <br /> TAXABLE&LES <br /> r <br /> CWS 42R 450 Styra <br /> BOTU DEPOSITS <br /> BxJef 8ottier <br /> on Hard kwiwd Saks Tax <br /> f TOTAL <br /> Mull NO(SET) IPU) <br /> Recenee - 5 Che* Cash( 1 <br /> on A:counr. rip, <br /> Fj Iq; - Equipment Lease <br /> I am V Cuss r or fbthor2edpy the Customer Agreement Accepted,initial <br /> i to aCpt the t rm Of t/his and Accepte odesto Bottled Water,Inc, <br /> have Ived listed ems, + <br /> Title' Date Installed; <br /> i <br /> Pmt Name <br /> i' rr lvr OFFK E WM47E "70M LIZ-YELLOW ACCOUNrIW-PINK <br /> AA PUNT#(M131-71f7 <br />