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Kinsey Central <br /> Heat & Air- Conditioning, Inc. <br /> A rt D /� y P.Q. Box 2209 <br /> /� ' Zephyrhills, Florida 33539 -2209 <br /> (813) 782 -2300 CA- CO58626 <br /> • <br /> PHON DATE OF ORDER <br /> /3 i 7 2 - �/ 7.s v a -9,-67 <br /> NAME <br /> ' a/ ( DATE PROMISED <br /> ADDRESS / /�/.! //7+- � �/�y/J '� <br /> Lf cg / � V JF.'/✓ r 64,A APARTMENT <br /> CITY G <br /> MAKE MODEL SERIAL NO. <br /> ❑ ESTIMATE <br /> NATURE OF ❑ CASH <br /> SERVICE <br /> REQUEST V ❑ CHARGE <br /> QUAN. PART NO. DESCRIPTION PRICE AMOUNT <br /> • , 4,1 44 ii El <br /> . <br /> ; <br /> SERVICE PERFORMED <br /> TOTAL <br /> { MATERIAL <br /> TECHNICAL <br /> SERVICE TIME <br /> A Burge of l.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. Ca�omer is liable for any charges incurred in collecting this bier TAX <br /> DATE <br /> 7 *oat E COMPLETED <br /> CASH o °N -.• TOTAL <br /> TECHNICIAN CUSTOMER'S SIGNATURE <br />