TIME & MATERIAL AUTHORIZATION FORM

TIME & MATERIAL AUTHORIZATION FORM

Service Site Info
Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Contact Name*
First Last
Title*
Phone*
Email*
Billing Address: If different from site address
Company Name
Address
Street Address Address Line 2 City State ZIP Code
Payment Info
Tax Exemption Status
- Non-Exempt
- Exempt
Tax Exemption Form
Max. file size: 128 MB.
PO# (If Using A PO)
Upload PO If Needed
Max. file size: 128 MB.
***If you wish to provide a credit card please complete this form and then contact our customer care department at 630-986-8899 to complete the request.
Actual invoices charges shall be contingent upon actual services rendered and material provided.
Service Request Information
Manufacturer*
Model Number*
Serial Number*
Tech to evaluate unit. Not guaranteed to fix on first visit, return visit may be needed. Minimum of four hours billing for services based on these rates.
Additional Comments
Upload Additional Photos and Documents
Max. file size: 128 MB.
We are pleased to submit the Service Authorization Form to perform services on your equipment per standard Terms and Conditions. It is understood if acceptance of this proposal is acknowledged on the customer’s purchase order, such acceptance will be subject to the Terms & Conditions of this Service Authorization From with the same force and effect as though they were included on the customer’s purchase order.
*
I have read and understood the rates.*
*
I have read and agree to the terms and conditions.*
Consent*
By checking this box and typing my name below, I am electronically signing this application.*
Name*
First Last

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Name (and Company) * Last Name * Email Address * Phone * Zip Code * Critical Power Services Needs * I'm interested in 'TIME & MATERIAL AUTHORIZATION FORM'.