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CHECKLIST fPER CUSTOMER REQUEST Gregory HVAC, LLC NR 1615 <br /> AIVIouNT <br /> ❑ COMPRESSOR X� N 'b�, rljs �! 5 ,,, 7135 US Hwy 19 N. • New Port Richey, FL 34652 <br /> Office 727-312-5550 <br /> SUCTION: Fax 727-312-5434 D E � <br /> State Certification#CAC 1817514 03 <br /> HEAD: NAME' Wy <br /> .v STREET r 1 UNIT WORKPHONE <br /> CITY // G STr}TE ZIP <br /> SUPERHEAT: <br /> JOB <br /> LOCATION <br /> lohn Lr6 apm se./ MAK/ES MOD SERIAL NUMBER� <br /> SUBCOOL: �—�j a <br /> /} 1 (y ip G MAKE M EL SERIAL NUMBER <br /> r <br /> o <br /> ❑ REFRIGERANT <br /> f , <br /> ❑4113A 22 <br /> ` YES ❑ No PER CUSTOMER REQUEST 6'"'1 <br /> X Id i� i>t I <br /> ORA RCOIL PARTSWARRANTY ABSOLUTELY NO <br /> 14 <br /> All parts as recorded are warranted as per <br /> DIRTY CLEAN manufacturer specifications. REFUNDS ON 01 <br /> LABOR GUARANTY. ELECTRICAL PARTS. <br /> The labor charge as recorded here relative to the j <br /> equipment services as noted,Is guaranteed for a THERE IS A 20% / / <br /> period of 30 days. <br /> ❑ FILTER We do not,of course,'guaranty other parts than' ADMINISTRATIVE FEE <br /> those we supply.If repairs become necessary I <br /> ❑ DIRTY ❑CLEAN due to other defective parts,they will be ON ALL CANCELED <br /> charged separately. INVOICES. TECHNICIAN i' I <br /> SIZE: <br /> X X TYPE • SYSTEM E,CHANGED SUBTOTAL C, <br /> R r REFRIG. QTY. U ROUT(OREPLACED)? YES NO <br /> D El TERMS: DUE ���"��" �SZ DISCOUNT <br /> E O RECOVERED? ❑ ❑ QTY. 'P MANTLED? ❑ ❑ I HAVE THE AUTHORITY TO OR`ER T�B6VEM R�C AND DO 50 TRIP <br /> F YES No Ni YES NO ORDER AS OUTLINED ABOVE.IT 15 AGREED THAT THE SELLER WILL CHARGE <br /> ❑ BIOGROWTH R 'h REFRIGERANT DISPOSAL RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL <br /> RECYCLED? ❑ ❑ QTY. N FINALAND COMPLETE PAYMENTIS MADE,AND IF SETTLEMENT IS NOT TAX <br /> E]YES ❑ NO I YES No T © MADE AS AGREED,THE SELLER SHALL HAVE THE RIGHT TO REMOVE <br /> OUR PERSONNEL SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY DAMAGES TOTAL <br /> G ® RECLAIMED? ❑ CITY RECOMMEND: RESULTING FROM THE REMOVALTHEREOF. <br /> IF YES,WAS THIS YES o ' <br /> • EXPLAINED TO THE E. RETURNEDTo DEPOSIT <br /> HOMEOWNER? R. THIS SYSTEM? ❑ ❑ QTY. i U <br /> 4 , YES NO BALANCE <br /> •❑YES ❑ NO A � DISPOSAL AUTHORIZED SIGNATURE <br /> N ❑ ❑ :OWNER'S INITIALS ABOVE ORDERED WORK HAS BE COMPLETED AND I ACKNOWLEDGE RECEIPT OF MY COPY. <br /> CUSTOMER INITIALS T NON USABLE YES NO QTY. ACCEPTED DECLINED _x "I e /f <br /> OO DISPOSAL <br />