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DATE: _____________________
DELIVERY ADDRESS
Monthly
Quantity Unit Description Total
Rental
GRAND TOTAL
Items received are in good condition.
* Rented materials shall not be transferred to any place without the permission of Tin Mark Scaffolding Incorporated *
CONFORME:
__________________________________________
SIGNATURE OVER PRINTED NAME
Residence Address: __________________________________________________________________________________________________
Cellphone & Telephone Number: ______________________________________________ Bank Details:_____________________________