GENERAL DATA GENERAL CUSTOMER DATA

COMPANY NAME NAME OF COMPANY OR CUSTOMER

RESPONSIBLE FOR WORK RESPONSIBLE

WORK AREA ADDRESS

ADDRESS TELEPHONE
TELEPHONE E-MAIL
E-MAIL
RECEPTION OF
EQUIPMENT Folio: vvvvvvvvvvvvvvvvvvvv

DATE OF RECEIPT
DD MM AA

GENERIC DESCRIPTION
QUANTITY DESCRIPTION BRAND No. SERIAL TECHNICAL CONDITIONS

OBSERVATIONS OF THE COMPUTER EQUIPMENT PRIOR TO MAINTENANCE

COMPANY NAME AND SIGNATURE CUSTOMER'S NAME AND SIGNATURE

*Deliverupon receipt of the equipment to

stamp of receipt