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_� BAN-KOE SYSTEMS <br /> ❑ Minneapolis ❑ Grand Rapids ❑ Peoria SERVICE WORK SHEET <br /> '� -�L ❑ La Crescent ❑ Quad Cities ❑ Des Moines <br /> ❑ Sioux Falls <br /> Date: P�#� Approved by: <br /> Equipment Location Address: Invoice Address: <br /> Contact: Attention: <br /> Phone: Phone: <br /> Type of Service: Maintenance Agreement: Billable: Non-Billable: <br /> Preventive Maintenance None Labor Covered by PMA <br /> Phone Support D-Hardware Parts Prepaid Prof Serv./Install <br /> On Site O-Hardware Mileage Warranty <br /> Shop D-Software Shipping Other� <br /> Training Other* Adtl Prof Service <br /> Other* Ex.Date Other• <br /> •Explain Other: <br /> General Description of Problem: <br /> Equipment/Software Involved: Unit Serial #: <br /> Services Rendered: <br /> Parts Used: <br /> Qty Inventory Number Description Seria�# Price Each <br /> Labor: Mileage: <br /> Hours @ $ Per Hr = Miles @ $ Per Mile = <br /> DO NOT PAY FROM THIS COPY – AN INVOICE WILL FOLLOW <br /> Customer acknowledges the above work and/or services were performed and,if applicable,the equipment and supplies were delivered. <br /> Ban-Koe Representative Emp# Customer Representative Date <br /> White-Ban-Koe AccYg Yellow-Ban-Koe Service Pink-Customer <br />