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\ Warranty Aplication
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Coil & Fin Clear Protective Treatment
Quarterly Cleaning Maintenance Form
CUSTOMER INFORMATION:
SERVICE CONTRACTOR INFORMATION:
Date of Service Call:
Required
Invalid Format [MM/DD/YY]
Technician:
Required
Name:
Required
Company:
Required
Address:
Required
Address:
Required
City:
Required
City:
Required
State:
Required
Zip:
Required
State:
Required
Zip:
Required
E-Mail:
Required
Invalid Format
Certification #:
Required
EQUIPMENT INFORMATION
HVAC/R Unit Model:
Required
Serial Number:
Required
Present Condition of HVAC/R Unit
Numerical Rating of HVAC/R Unit Condition at Time of Servicing:
10
9
8
7
6
5
4
3
2
1
(10=like new condition, 1=close to critical failure)
[Use the photo comparative chart to determine present condition]
Is there evidence of increased corrosion since the last service maintenance call?
Yes
No
Is there a need to re-apply (touch up) any areas of the coil/fin with additional MicroGuard AD35 in order for the warranty to go full term?
Yes
No
Additional Notes:
FIELD SERVICING INFORMATION
Field Maintenance Servicing Check List:
Coil/Fin area cleaned with MicroKleen PLC-1 (diluted 1 : 20):
Yes
No
Tap Water Hose Rinsed:
Yes
No
Visual Check of Unit Condition:
Yes
No
Dated & Signed Unit Decal Recording Service Call:
Yes
No
Ordered MicroGuard AD35 Touch Up Kit:
Yes
No
Keep a dated copy on file of each Quarterly Service Maintenance Call.
