American Fence & Security Company Inc.

• Branch:

• Conducted on

  Date

• RO #:

• Customer Name:

• Location / Address
  Address

• Nearest Cross Streets:

• Lease Agent Name:

6' PANELS

• 6+0 Panels Total Quantity On-Site

• 6+0 Panels Unacceptable Installed On-Site

• 6+0 Panels Totally Damaged On-Site ($100 per panel)

• 6+0 Panels Partially Damaged On-Site ($50 per panel)

• 6+1 Panels Total Quantity On-Site

• 6+1 Panels Unacceptable Installed On-Site

• 6+1 Panels Totally Damaged On-Site ($100 per panel)

• 6+1 Panels Partially Damaged On-Site ($50 per panel)

7' PANELS

• 7+0 Panels Total Quantity On-Site

• 7+0 Panels Unacceptable Installed On-Site

• 7+0 Panels Totally Damaged On-Site ($100 per panel)

• 7+0 Panels Partially Damaged On-Site ($50 per panel)

• 7+1 Panels Total Quantity On-Site

• 7+1 Panels Unacceptable Installed On-Site

• 7+1 Panels Totally Damaged On-Site ($100 per panel)

• 7+1 Panels Partially Damaged On-Site ($50 per panel)

STANDS

• Total Quantity of T-Stands On Site -

• AFC Unacceptable T-Stands Installed -

• Totally Damaged T-Stands On Site -

• Partially Damaged T-Stands On Site -

BIG FEET

• Total Quantity of TSO Stands On Site -

• AFC Unacceptable TSO Stands Installed -

• Totally Damaged TSO Stands On Site -

• Partially Damaged TSO Stands On Site -

EXCEPTIONS OR ACTIONS NEEDED BY AFC CREW

DAMAGE CHARGES

• Number of Totally Damaged Panels -

• Total Cost of Damaged Panels $

• Number of Partially Damaged Panels -

• Total Cost of Partially Damaged Panels $

• Number of Totally Damaged T-Stands -

• Total Cost of Totally Damaged T-Stands $

• Number of Totally Damaged Big Feet Stands -

• Total Cost of Totally Damaged Big Feet Stands $

• Total Cost of Partially Damaged Big Feet Stands $

• Total Price Plus Tax $

  Yes

  No

  N/A

• Total Price Plus Tax:

SIGNATURES

• AFC REPRESENTATIVES SIGNATURE:

  Sign

• CUSTOMER SIGNATURE:

  Sign