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q? 5,,, ,,- K, .insey 'entrai <br /> Heat:& Air=Conditioning,anc. <br /> P.O. Box 2209 <br /> Zephyrhills, Florida 33539-2209 <br /> (813) 782-2300 CA-CO58626 <br /> p5{ DATEOFORDER <br /> �l <br /> NAME ' 'DATE PROMISED <br /> ADDRESS 0ARTMENT — <br /> lf7 <br /> 1 CITY <br /> a <br /> MAKE MODEL SERIAL NO. <br /> ❑ ESTIMATE. <br /> NATURE OF ❑ CASH <br /> SERVICE <br /> REQUEST ���iiT"' ❑ CHARGE <br /> QUAN, PART NO. DESCRIPTION PRICE AMOUNT <br /> I <br /> 1 I <br /> I <br /> j <br /> fj <br /> I <br /> SERVICE PERFORMED TOTMATEAL IAL I" <br /> j TECHNICAL l <br /> SERVICE TIME <br /> c � ' <br /> A charge of 1.5116 will be made on all unpaid balances after 3Qdays,which is an annual percentage rate TAX l <br /> j of t B%applied to past due balances.Customer is liable for any charges incurred in collecting this bill. <br /> DATE COMPLETED CA$n ON CORKLETION TOTAL. <br /> l <br /> t <br /> TECHNICIAN CUSTOMER'S SIGNATURE <br />