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INTEL CAPITAL EQUIPMENT ACCEPTANCE CERTIFICATE
(To be completed by supplier representative.)
This is to certify that the following capital equipment meets the final acceptance
criteria as specified in the Intel Purchase Specification. Final acceptance payments
are defined in Purchase Agreement # ___________ as
__________________________________________________________________________________________
____________________________________________________________________________________________
SHIPMENT INFORMATION
Equipment Description
Model
Mfg. No. (serial number)
Factory Tool I.D. #
________________________________________________________
Tool Locator # (if known)________________________________________________________
Intel Purchase Order #
Manufacturer
INVOICE INFORMATION
Original Invoice Number
Original Invoice Date
Month
Day
Year
Dollar Amount Due $_______________________________________________
(final percentage payment due; generally 20%)
ACCEPTANCE COMPLETE
Date of Acceptance
Month
Day
Year
Intel Signature
(Intel Engineer or IQ signature)
Print Name/Title
ACCEPTANCE NOT YET COMPLETE, BUT FINAL PAYMENT BEING MADE
_______Intel representative, check here and complete this section if final acceptance
criteria have not yet been met, but final payment is being made, per contract payment
terms. Release of final payment under this provision does not release either party of
their responsibilities provided for in other sections of the Purchase Agreement and
Specification.
Intel Signature
(Intel Engineer or IQ signature)
Date
Month
Day
Year
______________________________________________________________________________
Supplier Service Engineer ________________________________________________
(signature)
Print Name/Title
Supplier Instructions
Send completed form to the “Bill To” address listed on the Purchase Order. However,
if the “Bill To” location is Hillsboro, Oregon, fax a copy of the completed form to the
Intel Accounts Payable Percentage Payment Desk at (503) 696-3007.
Rev. 3/16/99
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