Date of Creation:(Required)

CLIENT INFORMATION

Client Name:(Required)
Client Address:(Required)

CONTRACTOR INFORMATION

Company Name(Required)
Contractor Full Name(Required)
Company Address:(Required)

EQUIPMENT

EQUIPMENT(Required)
Item
Model
Serial Number
 

FUTURE ACTION REQUIRED AND/OR REMARKS

By signing this document, the Client acknowledges that all equipment is installed and is functioning properly and in good working order and the Contractor acknowledges that they have completed installation.

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