HVAC

YOUR BUSINESS NAME HERE SERVICE ORDER/INVOICE

PHONE NUMBER LINE
ADDRESS LINE 123456
ADDITIONAL ADDRESS LINE
YOUR CITY, STATE 12345

THIS WORK IS TO BE
BILL TO
C.O.D. CHARGE NO CHARGE
MAKE MAKE

MODEL MODEL

SERIAL NUMBER SERIAL NUMBER

NAME
ENVIRONMENTAL CHECK LIST WORK PERFORMED
STREET DATE WORK PERFORMED QTY. TYPE/DISPOSITION CONDENSING UNIT COND’SATE DRAINS
CLEANED
RECOVERED LEVELED
MAIN DRAIN
CITY PROMISED
REPAIRED
RECYCLED CLEANED COIL
MAIN DRAIN
PHONE CALL BEFORE A.M. RECLAIMED
CHECKED CLEANED
CHARGE PAN DRAIN
P.M. REPAIRED REPAIRED
▼

▲
RETURNED LEAK IN COIL PAN DRAIN
TECHNICIAN AUTHORIZED BY
REPAIRED
DISPOSAL LEAK IN COPPER FURN. OR FAN COIL
WORK TO BE PERFORMED DISMANTLED #REF. REPLACED BELT
CHANGED OUT/REPLACED
TOTAL $
CHECKED
MOTOR ADJUSTED BELT

QTY. MATERIALS & SERVICES UNIT PRICE AMOUNT DESCRIPTION OF WORK PERFORMED CHANGED
MOTOR
REPLACED
PULLEY
REPLACED ADJUSTED
REFRIGERANT R- LBS. BELT PULLEY
ADJUSTED CLEANED
BELT BLOWER
REPLACED REPLACED
CONTACTOR BEARINGS

SAMPLE - VOID REPL. START.

RELAY OILED MOTOR
REPL. START.
FORM 240044 CAPACITOR OILED BEARINGS
REPLACED RUN CLEANED
COLORS AVAILABLE CAPACITOR HEAT EXCH.
CLEANED OR REPLACED
BLACK ADJ. CONTACTOR HEAT EXCH.
REPAIRED CLEANED OR
REFLEX BLUE WIRING ADJ. PILOT
REPLACED
GREEN PMS 347 REPLACED FUSE
THERMOCOUPLE
REPLACED REPAIRED
BURGUNDY PMS 221 COMPRESSOR VALVE
REPLACED
EVAPORATOR COIL
Parts Available VALVE
REPLACED CLEANED
3 Part Only EXP. VALVE
ADJUSTED
BURNERS
DUCT
2nd part 3rd part EXP. VALVE
REPLACED
REPAIRED
Yellow Mamila Tag CAP. TUBE
FILTERS X X CLEARED
ADJUSTED
CAP. TUBE
REPAIRED
COIL LEAK THERMOSTAT
FILTERS X X
REPAIRED
COPPER CONN. REPLACED
BELTS
▼

▲
CLEANED COIL ADJUSTED

LEVELED COIL
TOTAL MATERIALS
ELECT. HTR. CLG TOWER
HRS. LABOR RATE AMOUNT RECOMMENDATIONS REPLACED LINK CLEANED

REPLACED KLIX

REPAIRED WIRE PUMP(S)

REPAIRED CONT. GREASED

REPAIRED

FILTERS CLEANED REPLACED

TOTAL LABOR LIMITED WARRANTY: All materials, parts

and equipment are warranted by the TOTAL SUMMARY
TERMS manufacturers’ or suppliers’ written warranty
only. All labor performed by the above named TOTAL
TERMS IMPRINT AREA.
company is warranted for 30 days or as MATERIALS
otherwise indicated in writing. The above TOTAL
named company makes no other warranties, LABOR
express or implied, and its agents or
I have authority to order the work outlined above which has been satisfactorily completed. I agree that
Seller retains title to equipment/materials furnished until final payment is made. If payment is not made technicians are not authorized to make any
as agreed, seller can remove said equipment/materials at Seller’s expense. Any damage resulting from such warranties on behalf of above named
said removal shall not be the responsibility of Seller. company. TRAVEL
CHARGE
REGULAR WARRANTY
SERVICE CONTRACT TAX
X
CUSTOMER SIGNATURE DATE Thank You TOTAL
240044