LIMITED WARRANTY: All materials, partsand equipment are warranted by themanufacturers’ or suppliers’ written warrantyonly. All labor performed by the above namedcompany is warranted for 30 days or asotherwise indicated in writing. The abovenamed company makes no other warranties,express or implied, and its agents ortechnicians are not authorized to make anysuch warranties on behalf of above namedcompany.

DATE

PROMISED

CALL BEFORE

AUTHORIZED BY

FILTERS X X

FILTERS X X

BELTS

REFRIGERANT R- LBS.

THIS WORK IS TO BE

MAKE

MODEL

SERIAL NUMBER

MAKE

MODEL

SERIAL NUMBER

QTY. MATERIALS & SERVICES AMOUNT

HRS. LABOR RATE AMOUNT

ENVIRONMENTAL CHECK LIST WORK PERFORMED

WORK PERFORMED QTY. TYPE/DISPOSITION

RECOVERED

RECYCLED

RECLAIMED

RETURNED

DISPOSAL

DISMANTLEDCHANGED OUT/REPLACED

DESCRIPTION OF WORK PERFORMED

RECOMMENDATIONS

CONDENSING UNIT COND’SATE DRAINS

LEVELED

CLEANED COIL

CHECKEDCHARGEREPAIREDLEAK IN COILREPAIREDLEAK IN COPPER

#REF.

CHECKEDMOTORCHANGEDMOTORREPLACEDBELTADJUSTEDBELTREPLACEDCONTACTORREPL. START.RELAYREPL. START.CAPACITORREPLACED RUNCAPACITORCLEANED ORADJ. CONTACTORREPAIREDWIRING

REPLACED FUSE

REPLACEDCOMPRESSOR

EVAPORATOR COIL

REPLACEDEXP. VALVEADJUSTEDEXP. VALVEREPLACEDCAP. TUBECLEAREDCAP. TUBEREPAIREDCOIL LEAKREPAIREDCOPPER CONN.

CLEANED COIL

LEVELED COIL

ELECT. HTR.

REPLACED LINK

REPLACED KLIX

REPAIRED CONT.

FILTERS

CLEANEDMAIN DRAINREPAIREDMAIN DRAIN

REPAIREDPAN DRAIN

FURN. OR FAN COIL

REPLACED BELT

ADJUSTED BELT

REPLACEDPULLEY

CLEANEDBLOWERREPLACEDBEARINGS

OILED MOTOR

OILED BEARINGS

CLEANEDHEAT EXCH.REPLACEDHEAT EXCH.CLEANED ORADJ. PILOTREPLACEDTHERMOCOUPLE

REPLACEDVALVE

REPAIREDVALVE

ADJUSTEDPULLEY

CLEANEDPAN DRAIN

CLEANEDBURNERS

DUCT

REPAIRED

ADJUSTED

THERMOSTAT

REPLACED

ADJUSTED

CLG TOWER

CLEANED

PUMP(S)

REPAIRED

GREASED

TOTAL SUMMARY

TOTAL

CLEANED REPLACED

TOTAL MATERIALS

TOTAL LABOR

240044

CUSTOMER SIGNATURE DATE

X

TOTAL $

WARRANTY

SERVICE CONTRACT

REGULAR

A.M.P.M.

Thank You

TERMS

REPAIRED WIRE

I have authority to order the work outlined above which has been satisfactorily completed. I agree thatSeller retains title to equipment/materials furnished until final payment is made. If payment is not madeas agreed, seller can remove said equipment/materials at Seller’s expense. Any damage resulting fromsaid removal shall not be the responsibility of Seller.

TOTALMATERIALS

TOTALLABOR

TRAVELCHARGE

TAX

BILL TO

UNIT PRICE

NAME

STREET

CITY

PHONE

TECHNICIAN

WORK TO BE PERFORMED

NO CHARGECHARGEC.O.D.

▲▲

▼▼

SERVICE ORDER/INVOICEHVAC

123456

YOUR BUSINESS NAME HEREPHONE NUMBER LINE

ADDRESS LINEADDITIONAL ADDRESS LINEYOUR CITY, STATE 12345

SAMPLE - VOIDFORM 240044

COLORS AVAILABLEBLACK

REFLEX BLUEGREEN PMS 347

BURGUNDY PMS 221

TERMS IMPRINT AREA.

Parts Available3 Part Only

2nd part 3rd part Yellow Mamila Tag