Triangle Tube Labor Allowance Request (Contractor)

Model*

Serial Number*

Date of Visit*

Date

Contractor Company*

Technician Name

Contractor Address*

Contractor Address Line 2

Contractor City*

Contractor State / Province*

Contractor Postal / Zip Code*

Contractor Country

Contractor Contact Number*

Please enter a valid phone number.

Contractor Email Address*

example@example.com

Installation Address*

Installation Address Line 2

Installation City*

Installation State / Province*

Installation Postal / Zip Code*

Installation Country

Upload Internal Revenue Service W-9 Form*

*Required for all US persons as defined in Internal Revenue Service Form W-9 Request for Taxpayer Identification Number and Certification Instructions.

Labor Request*

$135 for Parts Replacement$400 for Heat Exchanger Replacement$500 for Smart Tank and Cardinal Tank Replacement

Debit Memo / Contractor Reference Number

Description of Work

Please allow 4-6 weeks for processing upon arrival.