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JOB NAME: <br />ADDRESS: <br />CITY: <br />HOME PH: <br />J.H. SIMPSON CO. <br />State License No. 334724. <br />402-) Coronado Ave. <br />P.O. Box 8640 <br />Stockton, California 95208 <br />Phone(209)466-1477 <br />`7 1 <br />9 <br />STATE: ZIP: <br />BUS. PH. <br />TROUBLE AS REPORTED: <br />D <br />❑ T & M ❑ CONTRACT ❑ WARRANTY ❑ C.B. <br />DIAGNOSIS: C n <br />-# L® 2. -4, r-;Si(n k►Z�l <br />❑ MATERIALS <br />ONLY <br />RECEIVED PROMISED P.O. NUMBER <br />J Z <br />AUTHORI ED BY SPECIAL INSTRUCTIONS. <br />G' - <br />CALLED IN BY. <br />BILL TO: <br />ADDRESS: <br />CITY: STATE: PH. <br />)TY. SOURCE MATERIALS PARTS & EQUIPMENT UNIT <br />PRICE <br />FILTERS X X <br />FILTERS X X <br />BELTS <br />GENERAL SERVICE SUPPLIES <br />TOTAL MATERIALS, PARTS & EQUIPMENT <br />UNIT <br />QTY. OTHER SERVICES PRICE <br />VACUUM PUMP <br />WELDING EQUIPMENT <br />LEAK DETECTOR <br />PRESSURE CLEANER <br />PERMIT <br />CRANE LIFTING EQUIPMENT <br />RENTAL(S) <br />OTHER(S) <br />TOTAL OTHER SERVICES <br />1100 <br />10037 <br />JOB ORDERANVOICE <br />TYPE OF UNIT: <br />MAKE' <br />MODEL <br />AMOUNT SERIAL NO. <br />I <br />MAKE <br />I <br />MODEL <br />1 <br />SERIAL NO. <br />I <br />I <br />TOTAL MATERIAL <br />MINIMUM i HOUR <br />SERVICE ARGE <br />LABOR: <br />HRS. <br />OTHER SERVICES C <br />I <br />I C <br />I <br />I � <br />I <br />TAX C <br />t D <br />I PAY THIS AMOUNT qq C <br />0 <br />THANK YOU! <br />I <br />I <br />I <br />1 <br />AMOUNT CARD NO. <br />EXPIRATION DATE <br />1 - <br />SERyICE PERS DATE <br />IHAVEITY TO ORDER THE WORK WHICH HAS BEEN <br />SATISFAC PERFORMED, AS ABOVE. I AGREE THAT THE <br />SELLER WILL RETAIN TITLE TO ANY EOUIPMENT OR MATERIAL <br />THAT MAY BE FURNISHED UNTIL FINAL PAYMENT IS MADE, AND <br />IF PAYMENT IS NOT MADE AS AGREED, THEN SELLER SHALL <br />HAVE THE RIGHT TO REMOVE SAME AT SELLERS EXPENSE, AND <br />ANY DAMAGES RESULTING FROM SAID REMOVAL SHALL NOT <br />BE THE RESPONSIBILITY OF SELLER. ANY "SAME TROUBLE - <br />REPORTS MUST BE RECEIVED IN OUR OFFICE WITHIN TEN (10) <br />DAYS. <br />I y <br />I A <br />CUSTOMER SIGNATURE <br />1 <br />1 <br />C.O.D. <br />0 INSTALLED LOGO <br />