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C COMMERCIAL DISHWASHING AND SANITIZING SOLUTIONS INVOICE# 346764 <br /> Branch# )�G <br /> SYSTEM <br /> Route If <br /> Customer Name: s^ c o �II1'ri I �� L� Customer Number <br /> Address: /�44 (,�tC� L'l1 <br /> Date: <br /> City: State: CA Zip: r) S l v <br /> Mach# Serial No. Todays Meter ReadinqI Last Meter Reading Cycles Washed I Racks/Cycles Racks Washed Dishwasher Minimum Charge <br /> 3 $ <br /> Extra Rack Cha es <br /> Dish Machine Products $ <br /> Product# Product Name O Delivered OH Last SeryUnused USed ML uses ML Avowed ML Excess ML Unit Price Net Amount <br /> >x Det. <tA �C SC,AI .'� v ! 2 . r $ <br /> m <br /> Z' Rinse I tAl. VypC11A.e.a Is <br /> 2� San. Is <br /> # Det. <br /> Is <br /> – Rinse t r. Y14 <br /> T" $ <br /> m $ <br /> � San. <br /> = Det. $ <br /> m — <br /> Rinse $ <br /> U <br /> San. I I I I I I $ <br /> Product# Product Name Billinq Unit On Hand Delivered Today Unit Price Net Amount <br /> $ <br /> Received On Account Information Fuel Surcharge $ <br /> Invoice No(s)Paid Today Invoice Date I Amount Sub Total $ <br /> �i0wI 'ILI � Is State Tax $ <br /> J Customer Signature $ Local Tax $ <br /> $ 0601 <br /> Total ROA Collected Today $ Today's Invoice Total $ <br /> J Auto-Chlor Signature Today's Invoice Payment Information: <br /> Cash Check If Moll Cash❑ Charge❑ Check# <br /> xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx <br /> Please pay from this invoice-Terms:Invoices not paid within 28 days are subject to a Finance Charge of 18%per Annum or the maximum amount permitted by law. <br /> NO STATEMENT WILL BE SENT. <br /> Customer#: Invoice No(s) Amount Paid: $ <br /> Thank You For Your Businessl <br /> F007 White/Original-Branch Yellow-Customer Pink-Accounting www.autochlor.com <br />