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: <br />Date received: <br />Date received: QTY: <br />Deposit <br />. . _ <br />Deposit amount: $ <br />Control amount: $ <br />Verification. <br />COMMISSARY EL GALLO AGREEMFA <br />Mobile Truck Form Account # <br />To receive any discounts, purchase must be fully paid in CASH. No debit or credit transactions allowed. <br />j Ownez .1:M7011-nation TII <br />Date: <br />Name: & t <br /> // Home Address: ".;"-:5'i,,;---7/-; A/7/e,', c- 742 A/ e _7 e; c "1-.7 City_L______StateC_-AL Zip Code 4 7 Cell #. c-i6i ----pc7 ---23_5 Home # <br />Email address: -7-e'r? e- , 7) • e , ci-14 <br />:_. - . .. . .__...... <br />Business. Information <br />Business name:e n .- e - ',:z-'‘ 5 Owner/Operator Name: ,,.e-, Lie Plate # <br />Business Address: k36-.- (z-ih.biel-c)-e?‘ c;--1,--vlse'el./ <br />e <br />City ,_____2ej c_p__2z1___state6', Zip Code e/ cl.??‘_"•(: Business Phone # ,;2 Oe 3c; _2 :2 -;c:i Alt # ,;? 0 -,/ <br />Document Check List <br />Sellers Permit: <br />Date received: Permit #: <br />Verification Date: By: (Commissary use Only) <br />The following forn2s/docu1)lents will need to be updated each year, along with ID/DL and phone numbers. <br />Auto and/or Liability Insurance: <br />Date received: <br />FAX <br />SJ/e I e <br />Truck Registration: <br />Date received: <br />By signing below, I certib; all information is true and correct to the best of my knowledge. <br />Signature of Applicant: ( - Date: ".7