SERVICE WORK ORDER FORM SCHEDULE DATE:

RESPONSIBLE OFFICE : ___________ CSR ID:

WORK ORDER No: _________________________________________ SUFFIX: _________________
REQUESTED BY: COMPANY: TELEPHONE NUMBER: TIME: DATE:

SERVICE REQUIRED AT: INVOICING (BILL TO) INFORMATION ORIGINAL WORK REQUEST
COMPANY I.D.# COMPANY I.D.#
Diagnostico de falla PowerFlex 755
Johnson Controls
ADDRESS ADDRESS

Lima
CITY STATE ZIP CODE CITY STATE ZIP CODE

Lima
SERVICE CONTACT ATTENTION
DAVID CHAPOÑAN PASCO
TELEPHONE NUMBER EXT. TELEPHONE NUMBER EXT.

956790944
PRODUCT SERIAL: PURCHASE ORDER No. RELEASE No.

CUSTOMER PRODUCT REF No: CONTRACT No. AUTHORIZED BY

PowerFlex 755

SMS ID No. MODEL No. WORK COMPLETED AND OBSERVATIONS

MONTH: Mayo BILL FUNC DIV/ PURCHASE ORDER TOTAL REPAIR CODES:
DAY OUT TIME START TIME END TIME IN TIME CODE CODE OFC ACCOUNT NUMBER HOURS CAUSE CODES:
16-May 09:30 10:00 15:00 15:30 6.0 DETAILS:
16: Inspeccion de equipo

SOTCK RETURN-TO
PSR NUMBER B∕W PART / CATALOG No.
LOCATION LOCATION

CUSTOMER AUTHORIZATION: TIME DATE

SERVICE ENGINEER:

HOURS SUMMARY EXPENSES (DIV/OFC) (DIV/OFC) CAP CARD LEFT

WITH CUSTOMER
YES/NO
LABOR HRS. 5.0 ST(x1) 5.0 OT(x1.5) 0.0 OT(x2) 0.0 $ $Parts $Misc. $
CALL BACK DATE
TRAVEL HRS. 1.0 ST(x1) 1.0 OT(x1.5) 0.0 OT(x2) 0.0 $ $Air &Car/Taxi $
CUSTOMER SATISFIED YES/NO
STAND BY HRS. ST(x1) OT(x1.5) OT(x2) $ $Mileage $Meals $
SERVICE COMPLETED YES/NO
RATE FIXED RATE $ $Lodging $
REVIEW REQUIRED YES/NO
SHIPPING/HANDLING CHARGES $ TOTAL CHARGES DETERMINED AT TIME OF INVOICING $

NOTWITHSTANDING ANY DIFFERENT OR ADDITIONAL TERMS THAT MAY BE EMBODIED IN CUSTOMER'S ORDER, CUSTOMER AGRESS THAT THE PRODUCTS SET FORTH ABOVE HAVE BEEN PROVIDED PURSUANT TO THE TERMS
AND CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE HEREOF. ALLEN-BRADLEY HEREBY EXPRESSLY OBJECTS TO ANY ADDITIONAL OR DIFFERENT TERMS AND CONDITIONS PROPOSED BY CUSTOMER.

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