Free Trial User Receipt/Agreement
Name: _____________________________________________________________ Address: ___________________________________________________________ City: _________________________ State: _____________ Zip: _______________ Phone #: _____________________ Alternate Phone #: ______________________ Best Time To Call: ______________________ AM ______ PM ______ Date Of Placement: _________________ Date To Finalize: _____________________ I Acknowledge Receipt of:
Qty: _____ Qty: _____ Qty: _____
Model: ____________________________ Serial #: _____________ Model: ____________________________ Serial #: _____________ Model: ____________________________ Serial #: _____________
Other: _____________________________________________________________ In home/store/office evaluation for _____ days. I agree to either return or purchase the unit(s). Should the merchandise disappear, become missing or become materially damaged, the trial user shall be responsible for the cost of repair or replacement. The trial user shall also be responsible for any costs encountered by the local distributor in locating and recovering the merchandise and / or monies due including but not limited to actual expenses, interest and reasonable Attorney fees.
______________________________ ____ EcoQuest Representative (print)
____________________________________ Free Trial User (print)
__________________________________ EcoQuest Representative (signature)
____________________________________ Free Trial User (signature)