Confirmation of tool expiry form

I (first name and last name in block letters) ………………………………………………………………………………

as legal representative of the company
Full stamp

hereby agree to ‘freeze’ the software on the current version of my TEXA tool with the serial number as listed below,
in exchange for the additional discount as part of the TEXA product upgrade program.

SERIAL NUMBER OLD TOOL DESCRIPTION

The Customer accepts that the old instrument (s) can no longer be updated, and also commits to not giving the old
tool/s indicated above to third parties.

Date ____________________ Customer

_____________________________
(Stamp and signature)

I hereby state that the signatures on this form are real and authentic and were put in my presence by the Applicant
as the Owner/Legal Representative of the firm/company indicated above and the personal data was verified by
examining the identification documents.

TEXA Distributor
____________________________
(Stamp and signature)