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96
308607
Horizon Form #6
Horizon Fluid Management Systems
Warranty Registration and Checkout Form
1. Site Identification
Customer Name: Bob’s Service Garage
Address: 123 Main Street
City/State/Zip: Anytown, USA 12345
Phone Number: (612) 555--1234
Key Contact Name: Bob Anderson
2. Installer Identification
Company Name: Pumps ’R Us
Address: 9876 Elm Street
City/State/Zip: Anytown, USA 12345
Phone Number: (612) 555--9876
Key Contact Name: Joe Good
3. System Hardware Identification and Checkout
Master Control Module
Slave Control Module(s)
Administrative Keypad
Enhanced Keypad/Barcode Reader
Basic Keypad
Air Solenoids
Fluid Solenoids
Oil Pulse Meters
AntiFreeze/WWF Pulse Meters
# in System
Operation Verified?
1
Y
3
Y
1
Y
0
N
3
Y
3
Y
9
Y
9
Y
0
N
4. System Software Identification & Checkout
(check if/when completed)
Run Options Configured:
Passwords
Yes
Job #
Yes
Vehicle ID
Yes
Optional Field Yes -- Miles
Presets?
Yes
Output Options Configured: Printer
Yes
Computer
Yes
5. Attachments (MANDATORY!)
Yes
(check when attached)
Yes
Yes
Copies of all System Design Forms
Copy of system map/floor plan
Printout of Software Setup
6. Installer Signoff
I certify that I have checked out all system
components and functions, and that they
operate according to system design specs
and customer expectations.
Installer Name:
Joe Good
Company:
Pumps ’R Us
Date Completed:
10/10/96
7. Customer Signoff
I agree that the system has been installed to my
expectations and that I have been informed as to proper
system operation. I accept control of the system.
Customer Name:
Bob Anderson
Company:
Bob’s Service Garage
Date Completed:
10/10/96
Summary of Contents for Horizon Fluid Management Systems
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