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R&M Work Order <br />attention Manager: <br />�- complete this formfor every <br />R&M invoice. <br />airs &Maintenance Log. <br />Record the service call in the Rep <br />All invoices must Include a completed R&M Work Order form and <br />rnvetstops� a meet <br />co,ftrsw�e Service Channel Work Order number to be considered for p y <br />as the p0# on invoice <br />255091 <br />Store Numberor Ci_ ty.- /-�te <br />Service Channel Work Order # <br />Use the Service Channel Work Order number invoice/Service Ticket Number: <br />Service Company: &J e l sz- <br />.-.. Date Work Performed: cl <br />Technician Name: =� <br />Detailed description of work performed & equipmen, lJI 1 41l <br />i,�c l,cc rt �4— <br />o, /A --S IdVt✓�if i 11 <br />Parts/Materials Used <br />Store Representative <br />StartTime <br />pate Store <br />acknowledge the satisfactorycompletion of the above described work ana <br />ted <br />the materials and time involved are accurate as represen. <br />Original Co o Vendor/Invoice and Carbon Copy to Store Manager <br />on the reverse side <br />ns <br />tions <br />This Mdocument, shall govern your conduct, resp Work order (the "Work Order") and the ri <br />is ntiesCand iprinted obligations n relation to the servioces <br />itsel <br />with and <br />provided, materials used, er, including without limitationathe Term &'Condtions, f and acknowledges <br />the terms of this Work Ord , <br />Vendor's acceptance of same by its provision <br />ilers (as pe State requirements) <br />rials or partso <br />Love's R&M Work order must accompany Invoice and lien wa <br />to be considered for payment. <br />a <br />On Siteiabor <br />End Time <br />Total Hours <br />i.» <br />Love's Corporate Office: <br />(800) 388-0983 <br />Send Invoices to: <br />PO gox26210 <br />Oklahoma City, OK 73126 <br />or <br />%Pinvokes@Loves.com <br />fax: 40511111 <br />