15710-0017-VRC | Rev G | 2023-11-15 | e-mail csd@pow.com Section 21 | 1
Section 21 | Acceptance
Certication - VRC
www.pflow.com
P 414 352 9000
F 414 352 9002
6720 N. Teutonia Ave.
Milwaukee, WI 53209
We, the Customer, accept the equipment listed below as being properly installed,
tested, and performing to our satisfaction. This form covers both the mechanical
and the electrical installation of the equipment. This acceptance in no way releases
either PFlow Industries, Inc. or the installing contractor(s) of any warranty
obligations. If there are any exceptions or unresolved items, please include detailed
information.
Please return a copy of this form to the PFlow Industries, Inc. Customer Support Department
at csd@pow.com.
Acceptance
PFlow Serial Number:
Model
Number:
☐
B
☐
D
☐
DB
☐
F
☐
M
☐
MQ
☐
21
☐
CV Othe r __________
Job Name:
Site Street Address:
Site Mailing Address:
Site City: State: Zip Code:
Customer Contact Name: Contact Title:
Customer Contact Phone: ( ) Ext E-Mail:
Load Capacity: Start-up Date:
Load Test: ☐ Yes ☐ No
at ____ % of li
capacity
Customer
Initials:
Operation Test: ☐ Yes ☐ No Comments:
Gate/Interlock
Operation:
☐ Yes ☐ No ☐ Not Applicable
Other Test:
Other Test:
Personnel Instructed on the Operation and Preventive Maintenance:
Name: Company:
Name: Company:
Accepted by: Acceptance Date:
Name/Phone: PFlow Rep Present:
Title: Name:
Company: Company:
Tests Performed