2010-08-01～2010-08-03
Code：2LONG-LOST
Category：LONG BOARD
Brand：LOST
Model：Model Name
Amount：$60
Total Amount：$60
I make a board rental by above contents. I return a board without any violation of an agreement. I make a payment for appropriate repair charges by the degree, by any chance when there was damage to a board.
Date： / /
Signature：