FACILITIES MANAGEMENT CORPORATION 



WAKE ISLAND 



COMMERCIAL 



STATEMENT OF SERVICE & SUPPLIES RENDERED 



N? 104 



AIRCRAFT NO. 

 ARRIVAL DATE 



FLIGHT NO. 



CAPTAIN 



Z DEPARTURE DATE 



_Z_ DESTINATION 



COLLECTED 



CHARGE 



RAMP SERVtCE 



FUEL SERVICE 



GAS 

 OIL . 



OCTANE 

 WEIGHT 



GALLONS @ 

 GALLONS @ 



% 

 t 



MAINTENANCE SERVICE 



NUMBER MAN HOURS 



PARTS (PER ATTACHED LIST) 



MEALS 



BREAKFASTS 

 LUNCH 



DINNERS 



IN-FLITE SNACKS 



0 

 9 



GALLEY SUPPLIES (PER ATTACHED LIST) 



LODGING 



NUMBER PERSONS 

 NUMBER PERSONS 

 NUMBER PERSONS. 



NUMBER NIGHTS 

 NUMBER NIGHTS 

 NUMBER NIGHTS 



PERSONS FOR 



NIGHTS 9 



PER NIGHT 



Miscellaneous charges or per "List Attached" 



1 Javr •: -r : errt^L Vrm -xsrlod liarch 7 -JLO, VKO ,'.00 p /dcy 



TOTAL CASH COLLECTED 



■i m 



TOTAL AMOUNT DUE FMC 



* THIS AMOUNT IS DUE AND PAYABLE, PLEASE REMIT 

 TO FACILITIES MANAGEMENT CORPORATION 



/ Certify that I have read the above statement, and that the charges are true and correct* 



t% &# I III— u 



AIRCRAFT CAPTAIN - CUSTOMER REP. 



DATE PREPARED 



F.M.C. REPRESENTATIVE 



STATEMENT 



