INSERT IN THIS DIRECTION THIS SIDE UP CARD NO. 08 194 254 6 SOLD TO YALE UNIVERSITY SERVICE BUREAUS TOWN & STATE EXPIRES ON LAST DAY OF MONTH YEAR Purchased from JACK E WEBER 2201 FORD TOWN & STATE 7 DATE 8-26161 STANDARD TIRE GUARANTEE AND ADJUSTMENT AGREEMENT DO NOT RUN THIS TIRE FLAT SERIAL NUMBER 6A6Y987 SIZE 260-15 PLY 4 DEALER CHECK ONE BOX IN EACH SECTION ATLAS BRAND BUCRON CUSHIONAIRE (Plycon or other) GRIP-SAFE WEATHERGARD TRUCK TIRES SIDEWALL BLACK WHITE TYPE TUBE LESS TUBED SERVICE PASSENGER COMMERCIAL GUARANTEE ADJUSTMENT DATA DESCRIPTION OF DAMAGE DATE OF ADJUSTMENT STATION NUMBER DISTRICT NO. ADJ. UNITS ADJ. COST PER UNIT $- CUSTOMER PAYMENT $- STATE SALES OR USE TAX & MUN. TAX $- TOTAL AMOUNT COLLECTED $- FOR OFFICE USE 679 PAGE NO. ALLOWANCE APPROVED BY HOLD FOR ATLAS REP. CHECKED TO FORM 04-114 # BY TREAD DEPTH ADJ. OR TIME ADJ. REPAIR ALLOWANCE $- (Support with Statement of Charges) CUSTOMER'S SIGNATURE DEALER'S OR OPERATOR'S SIGNATURE Send Tire Credit Acct. DEALER'S ADDRESS CITY STATE FORM 160 REV. 5-59