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<br />. DAT~ 1/1 ~~. <br />Building Style ' I . <br />X Roof Color .... C.." <br />X Roof Color <br />X / "7' Roof Color-S <br />X Roof Color <br />X Roof Color <br />X Roof Color <br />X Roof Color <br /> <br />~C>~ ~c-. fie- \)Ott~lcf. <br />] Name <br />.t;'03 f //~fk r:;::f- <br />Ma<rting Aodress <br />Z'Pthl{vA 1 il~ FI -53 ~:2~ <br />CIty I ~ State ZIp <br />Name of Employer \f& 11 I c.. ~ ~/ C\ If D <br />Social Security Numb~/?- S~ 9~ ~ 0 Driver's License Numb+H 1 ~ ~ - / ~ 1- ~~- -91.5=0 <br />Date of BirtWh,:,/'S- <br />/ / <br /> <br /> <br /> <br /> Size <br />am Size <br /> Size /8 <br /> , <br /> Size <br /> Size <br /> Size <br />Other Size <br /> <br />\ <br />BuildinK Inventory Number <br /> <br />~/~ <br /> <br />Sold To: <br /> <br />Rented To: <br /> <br />Xt <br /> <br />Location of <br />Delivery <br />(if different) <br /> <br />Name <br /> <br />~i})t/t1e <br />Physical Address <br /> <br />Sale Price <br />Options <br />Discount <br />Sub Total <br />State Tax <br />Local Tax <br /> <br />City <br />239~- <br /> <br />J't?Jo <br />/ <br /> <br />State <br /> <br />Security Deposit <br />Additional Deposit <br /> <br />< <br /> <br />> <br /> <br />Total <br />Tax Rate <br /> <br />A39~~ <br /> <br />Monthly Rent <br />Monthly Sales Tax <br />Monthly Local Tax <br /> <br />1~(j~9~ <br />/ 7;1: i,:' <br /> <br /> <br />Options <br /> <br />TOTAL MO. PAYMENY <br />Cost Directions <br /> <br />., - ...i'{i}~:-'../dt,}~\: ".' -.. <br /> <br />. .....- _"_~. _.~f <br /> <br />',;, ~: ~}~.~ ;'~:~E:;.; <br /> <br />~-.~ h. .,.......... <br /> <br />~J~5 <br />'i}J3 <br /> <br />Verified by Driver <br /> <br />All Weather Deli~r <br /> <br /> <br />Delivery D <br /> <br />Doors Loadea Toward <br />~]Cab <br /> <br /> <br />] Back Of Trailer <br /> <br />[ 1 Driver's Side <br /> <br />(please )J4lply all characters) <br />NevV" Used <br /> <br />I}J(J. ~h~~ () <br />Home Phone <br />78'.1 -. L.L~-h tJ <br />. Work Plione <br /> <br />Zip <br />Total Re703, 1..t... <br /> <br />COD,..... <br /> <br />I Jdil'/ n II I \ <br />H /ill/ lfJI1i/< 11M! <br /> <br />Note: Contract,delivery, fees are <br />collected" separately <br /> <br />Delivery Charge 7r <br /> <br />Delivery Collected. <br /> <br />.-..... <br />..... -" <br />".."fI.:' <br /> <br />". l!'~ ~ <br />. '. <br />: '-,--'" <br /> <br />;. <br /> <br />'. . <br />.. <br /> <br />[ ] Passenger's Side <br />