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COVINGTON GLASS <br />19403 SE 272ND ST <br />COVINGTON, WA 98042 <br />PH:(253) 981-3456 FAX:(253) 638-6494 <br />P/O#: Cust State Tax IDS <br />Taken By: DAN Cust Fed Tax ID: <br />Installer: Ship Via: <br />SalesRep: Adv. Code: <br />CLAYTON SNYDER <br />17941 MANASTASH RD <br />ELLENSBURG, WA 98926 <br />(435) 680-6440 <br />Make: Ford <br />Odometer: <br />Qty Part Number <br />1 DWO�TYNCOM <br />1 40F <br />1 HAH000004 <br />Thank You for your patronage <br />Customer Copy <br />Federal Tax ID: 538808067 <br />Workorder: W04809 <br />Date: 2/7/2017 <br />Time: 01:44 PM <br />CLAYTON SNYDER <br />17941 MANASTASH RD <br />ELLENSBURG, WA 98926 <br />Vehicle Information <br />Model Style: F Series F1504 Door Crew Cab Year: 2016 <br />VIN: License: <br />Description List Disc% tell Total <br />Windshield -(Ford -Oval in 3rd Visor $775.10 35 $504.47 $504.47 <br />Frit,Solar) <br />40 Flat (Flat Rate) $40.00 0 $40.00 $40.00 <br />Adhesive -(2.0, Urethane, Dam, Primer) $25.00 0 $25.00 $25.00 <br />AUTHORIZATION TO PAY <br />I hereby authorize and empower the above-named insurance company to pay this invoice in full settlement, <br />satisfaction and discharge of all loss under the above policy. Upon such payment, all rights I may have for <br />claim and demand for loss and damage described above against the above named insurance company shall be <br />thereby forever discharged. In the event that the above named insurance company does not make timely <br />and/or full payment of this invoice according to its terms, I hereby accept responsibility for such payment and <br />agree to pay all charges reflected on this invoice to the above named glass company subject to and according <br />to all terms and conditions on this invoice. _ <br />Collect From Customer $618.45 <br />Sub Total: $569.47 <br />Tax. $48.98 <br />Customer's Signature: Total. $618.45 <br />