Equipment Inventory

Distributor's Details
Name of Company
Contact Number
Area CodePhone Number
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Contact Person
First NameLast Name
Phone Number
Area CodePhone Number
E-mail
Date
MonthDayYear
Receiver Company Details
Contact Person
First NameLast Name
E-mail
Phone Number
Area CodePhone Number
Account Number
Signature
Amount of deductible per loss on insurance policy
(If known indicate) Policy number
Date
MonthDayYear
Department/Institution
Address of Institution
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Contact Person
First NameLast Name
Phone Number
Area CodePhone Number
Department Billing Code
Overall value to be insured
Item Details
Description Quantity Model Number Serial Number Cost Per Unit
Item 1
Item 2
Item 3
Total Number of Items
Total Cost
Location of Equipment
Date of Shipping
MonthDayYear
Contact Number
Shipping Cost
Should be Empty:

Distributor's Details