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3887 N. Valentine Ave.* Fresno, CA 93722*(559)444.1730 (--1Billable <br />License No. 779267 * AN EMPLOYEE OWNED COMPANY 1--3 Factory Warr. <br />Please Visit Our Website: www.icservices.com C= .90 <br />C= Not Billable <br />Bid Job <br />Dispenser Make <br />Dispenser Model: <br />Dispenser Serial #: <br />Pump Test: GallonE <br />Dollar Amt: <br />Description of Work Performed <br />Signature & Date 1 v " an J <br />n'a MH he reaporalee bra $75M booldefor,lee filmy/owaanunt ie assents b a f,M Pats bralledioa should ail he ournmenred <br />menlorte any of are terns of Nis agreement the Oreraive Perry awon erna,l In reasonaGe allareys lyes and the Cour) offead. <br />earl he In(your rounr) o,Freono Cour, M,e hereby gran' b yef or any assignee no Nhd In wry ampbymenl or nor a credo report to <br />ares mylow adli'y b fulfr mylour ffranial odgadun b fe agrmment <br />Ifmmmur®rlm by Wrefa r"fou"y, II flan' pem"ofthe to yon oft"" wyear aeslfra, a wnlaf rna/s by phone, If Oke are <br />uneadaae, erre raeontl, ea,, k ow -off., a messapz an" left pm. '.name a, prone number. <br />moss ghereise-Wer!)by tax, her War (LC SenrI hereby ero,"d,,,., allwarlanfns. earn vpra,Wo, bngied, indWing <br />'"I'M y 'hy a mrnir rd <br />laeaffy ness fora PaNw'up,rpnee, and hI asswnx nor amhotres am otn,personarum. <br />for wany rrabaryb oor Iwim me:ae ofcan polo's. <br />Qty Part No. <br />° 7 q'I cxo <br />h / re <br />/ <br />Inv. <br />Loc# <br />SR N0 1378Z1 <br />I <br />Date: <br />Work Order # ya 5C OL <br />Cost. P.0 # <br />Close Confir. # <br />Purchase Order It <br />1, give authorization to LC Services <br />Print Name <br />to run my credit card as form of payment. <br />Card #: <br />Card Type: Billing Zip: <br />Exp Date:_/_/ 3 Digit Security Code: <br />Name on Card: <br />Work Authorized by Date <br />Signature <br />A 3% CONVENIENCE FEE WILL BE APPLIED TO ALL CREDIT CARD TRANSACTIONS <br />Description & S/N Each Amount <br />/YI ..L/r <br />stop D/T <br />Total Labor <br />�IGj 1 1 Total Parts <br />R��m=rARMOM �l•i%S' <br />-FA rmS"AULDW <br />Sales Tax <br />)epart <br />=iveDepaft <br />3 <br />I U C— <br />stop D/T <br />Total Labor <br />�IGj 1 1 Total Parts <br />R��m=rARMOM �l•i%S' <br />-FA rmS"AULDW <br />Sales Tax <br />