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NAME OF OWNER:
_________________________________________
ADDRESS:
_________________________________________
_________________________________________
_________________________________________
PHONE:___________________________________
NAME OF DEALER:
_________________________________________
ADDRESS:
_________________________________________
_________________________________________
_________________________________________
PHONE:___________________________________
MODEL:___________________________________
SERIAL NUMBER:___________________________
DATE OF PURCHASE: _____________ (dd/mm/yyyy)
DATE OF INSTALLATION:___________(dd/mm/yyyy)
MAGNEHELIC AT INSTALL:___________________
INSTALLER’S SIGNATURE:
_________________________________________
NAME OF INSTALLER:
_________________________________________
ADDRESS:
_________________________________________
_________________________________________
_________________________________________
PHONE:___________________________________
MANUFACTURED BY:
SHERWOOD INDUSTRIES LTD.
6782 OLDFIELD RD. SAANICHTON, BC, CANADA V8M 2A3
www.envirore.biz
October 25, 2005
C-10985
Installation Data Sheet
The following information must be recorded by the installer for warranty purposes and future reference.