Repair Order

Product

Customer Signatur:

_______________________________________

Extended Retention of Title: Delivered goods remain the property of the supplier until full payment has been received. The supplier asserts the extended retention of title in any case. The recipient/client acknowledges the terms and conditions of delivery and sale printed on the reverse side by signing. Verbal agreements must be confirmed in writing to be valid.

To be filled out internally:

Estimated Repair Cost: ______________________

Effort: ____ Hours

Warranty: ___ Yes | ___ No

Additional Notes: