Custom
er: Date:
Machine T
ype:
Address:
Serial Number:
Contacts:
Phone: E
-mail/Fax:
Phone: E
-mail/Fax:
Phone: E
-mail/Fax:
T
his is to certify that the Air-Vac Representative __________________________________ has installed the
above machine and that all items have been received or are noted below. The machine is in good working order,
and initial training was provided.
Customer Signature/Date:
Air-Vac Representative Signature/Date:
I
ssues:
I
tems Missing:
P
lease fax this completed document to:
Air-Vac Engineering (203) 888-1145, Attn: Brian Czaplicki
AIR-VAC ENGINEERING COMPANY, INC.
INSTALLATION AND TRAINING
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