15710-0017-VRC | Rev F | 2022-02-01 | e-mail [email protected]
Section
20
| 1
Section
20
|
Acceptance
Certification - VRC
www.pflow.com
P 414 352 9000
F 414 352 9002
6720 N. Teutonia Ave.
Milwaukee, WI 53209
We, the Customer, accept the equipment listed below as being properly installed,
tested, and performing to our satisfaction. For the purpose of quality assurance
by PFlow Industries, Inc., this form covers both the mechanical and the electrical
installation of the equipment. This acceptance in no way releases either PFlow
Industries, Inc. or the installing contractor(s) of any warranty obligations. If there
are any exceptions or unresolved items, please include detailed information.
Please return a copy of this form to the PFlow Industries, Inc. Customer Support Department
Acceptance
PFlow Serial Number:
Model
Number:
☐
B
☐
D
☐
DB
☐
F
☐
M
☐
MQ
☐
21
☐
CV
Other __________
Job Name:
Site Street Address:
Site Mailing Address:
Site City:
State:
Zip Code:
Customer Contact Name:
Contact Title:
Customer Contact Phone:
( )
Ext
E-Mail:
Load Capacity:
Start-up Date:
Load Test:
☐ Yes
☐ No
at ____ % of lift
capacity
Customer
Initials:
Operation Test:
☐ Yes
☐ No
Comments:
Gate/Interlock
Operation:
☐ Yes
☐ No
☐ Not Applicable
Other Test:
Other Test:
Personnel Instructed on the Operation and Preventive Maintenance:
Name:
Company:
Name:
Company:
Accepted by:
Acceptance Date:
Name/Phone:
PFlow Rep Present:
Title:
Name:
Company:
Company:
Tes
ts P
er
formed
