Fluke TiR110, Ti100-FC User Manual

On-Site Evaluation Agreement

PLEASE COMPLETE, SIGN AND FAX [phone]) OR EMAIL ([e-mail])

Instrumart hereby loans the thermal imager listed below for evaluation for a 24 hour period. Instrumart agrees to provide customer with next day delivery and return shipping service through UPS. The ship-to and pick-up address must be the same as a UPS call tag will be coordinated by Instrumart for pick up at the end of the evaluation period. If the thermal imager is not available for pickup by UPS at the end of the evaluation, the recipient agrees to be charged daily rental fees of $100/day until it is picked up by UPS. The recipient also agrees to be invoiced for the full list price of the product if the unit is not returned to Instrumart within 10 days. The recipient also agrees to pay any expenses incurred by Instrumart to repair or refurbish any goods damaged as a result of the evaluation. The recipient agrees that any saved data/images remaining on an evaluation unit will become property of Instrumart and will be deleted upon return.

Company Name:	DUNS Number:	Tax ID Number:

Ship To Address	Bill To Address
Street:	Street:
City, State, Zip	City, State, Zip

Purchasing Contact Name:______________________________________________________________

Phone:	Fax:	email:

Account Payable Contact Name:__________________________________________________________

Phone:	Fax:	email:

Payment method to be used ONLY if goods are not returned within the evaluation period or if goods are not returned within 10 days. Instrumart will authorize a $500 credit card authorization hold that can last from 5 to 30 days depending on the issuing bank. This is for verification purposes only and your card will not be charged.

Credit Card Number

Name on Card	Expiration Date

___________________________________________________________

Signed By	Date
To Be completed By Instrumart Coordinator ONLY
Part Number:	Date Shipped:
Serial Number:	Tracking Number:
Condition:	Instrumart Representative:

35 Green Mountain Drive South Burlington, VT 05403 USA [phone] · [phone] · [phone] FAX Email: [e-mail] Website: www.instrumart.com

Instrumart is a registered trade name of Total Temperature Instrumentation, Inc. (“TTI”).