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' „ lchtieldCompany Work Acknowledgement <br /> • location <br /> Facrl-ty number <br /> d <br /> Contract work/order or autnorLZatron number <br /> /( <br /> On work v-ac- done at this <br /> Dal( <br /> location by. <br /> Cc^,:raclo• nanc <br /> .1hc cc--.,rac,o• haClF: •. <br /> and v:o•ked On <br /> 1 x� C <br /> c. — <br /> �' n <br /> Signature of dealer or his emp Date <br /> Signature of dealer (or employee)does not obligate dealer in any way. nor <br /> does it signify any approval of any work done. <br /> Contractor is responsible for filling out this form and obtaining signature. Any <br /> invoice for work not covered by a separate contract at a firm price must be <br /> accompanied by a completed copy of this form. <br /> Jr1�99 • <br />