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<br />,_________' I <br /> <br />''--- <br /> <br />- ~ <br /> <br />! NAME <br /> <br />ADDRESS <br /> <br />... <br /> <br />CITY <br /> <br />MAKE <br /> <br />NATURE OF c) <br />SERVICE <br />REQUEST <br /> <br />QUAN. PART NO. <br /> <br />SERVICE PERFORMED <br /> <br />Kinsey Central <br />Heat & Air-Conditioning, Inc. <br />p. O. Box 2209 <br />Zephyrhills, Florida 33539-2209 <br />(813) 782-2300 <br />I PHON> ~~ - 6'1 ~ <br /> <br />, <br /> <br /> <br />MODEL <br /> <br />SERIAL NO, <br /> <br />DESCRIPTION <br /> <br />TECHNICAl <br />SERVICE TIME <br /> <br />7~ ~D#I <br /> <br />A charge of 1.5% will be made on all unpaid balances after 30 days, which is an annual percentage rate <br />of 18% applied to past due balances. Customer is liable for any charges incurred in collecting this bill. <br />DATE COMPLETED <br /> <br />CASH g~ ~g~~LETION _ <br /> <br />TECHNICIAN <br /> <br />CUSTOMER'S SIGNATURE <br /> <br />TOTAl <br />MATERIAL <br /> <br />TOTAL <br /> <br />TAX <br /> <br />CA-C058626 <br /> <br />Jl-ATE OF ORDER I <br />-/ -lJ ? <br />, <br />DATE PROMISED <br /> <br />APARTMENT <br /> <br />o ESTIMATE <br />o CASH <br />o CHARGE <br /> <br />PRICE <br /> <br />AMOUNT <br /> <br />