SHOP COPY
BROCK TOOL COMPANY 1401 E. RIVERSIDE DR.
INDIANAPOLIS, IN 46202
Ph. 317.634.7575
NUMBER
DATE
R-
Fx. 317.636.0588
DATE SHIPPED
SERVING INDUSTRY AND CONTRACT ORS
ACCT. NO.:
SHIP VIA
CUSTOMER ORDER NUMBER
TAKEN BY
QUAN.
BROCK NO.
SHIPPED
MANUFACTURER
DESCRIPTION
SERIAL NO.
MODEL NO.
FILLED BY
DISC. DISC.
PER
P/C
PARTS LABOR
QUAN.
PART NUMBER
DESCRIPTION
PRICE EACH
TO BE FILLED BY PURCHASING DEPARTMENT DATE ORDERED
ORDER NO
FROM
EST COST EST PARTS EST LABOR
DATE
AMT OF TIME
SERVICEMANS INT.
DATE
AMT OF TIME
TOOL COMPLETED & CHECKED OUT BY:
TYPE GIVE ESTIMATE
VOLTAGE
BROCK WARRANTY
TELEPHONE NUMBER
NAME
NO CLAIMS OR RETURNS ALLOWED AFTER 6 DAYS OF RECEIPT OF SHIPMENT WITHOUT AUTHORIZATION
NEW TOOL WARRANTY
SPECIAL INSTRUCTIONS
FREIGHT CHARGES
CREDIT
ESTIMATE APPROVED BY
DATE
SERVICEMANS INT.