SI-2011-00308_0001.tif WASHINGTON COUNTY
Heating, Air Conditioning, Air Duct Cleaning, Fireplaces & More, Inc.
334 N. 16 Street — Blair, NE 68008
Phone: 402-533-2660
DATE: P.O. Number Job Number
INVOICE I LOCATION SERVICED: n BILLING INFORMATION:
NAME il�Ii /� ✓;u �4 c� a r Po r NAME �,6, �! C-
ADDRESS ADDRESS �� �D /� // /�/ c /
CITY Q ��c r STATE J4 ZIP CITY �S �f i �/ STATE_&2&_ZIP
PHONE PHONE /4 2 9 0 3 7./'
Make: Model. Serial•
Make: Model: Serial:
SERVICE REQUESTED: WORK COMPLETED ❑ WORK INCOMPLETE ❑ ATTACHMENTS Q
i
DESCRIPTION OF WORK: . /6" ;
P.O. # QUANTITY MATERIAL FURNISHED PRICE
j
i
Zin ('-
D -7 ` -_
Date Technician Regular Over Double Diagnosis Fee ................. $
Hours Time Time g
Parts............................. $
Materials ........................ $
Freight / Trip Charge....... $
Labor............................ $
_ Sub Total $
Total Hours %) Tax $
TOTAL
CUSTOMER AUTHORIZATION: This Document is for authorization for Invoicing.
SIGNATURE: X DATE: