Equipment Delivery Confirmation

This Delivery Confirmation certifies that the equipment described below was delivered on at .

DELIVERED BY:

Company:

Delivered By:

DELIVERY ADDRESS:

Address:

City: State: Zip:

RECIPIENT INFORMATION:

Name:

Business Name:

Phone: Email:

EQUIPMENT DELIVERED:

Equipment Type:

Make:

Model:

Serial Number:

Quantity:

CONDITION ON DELIVERY:

Condition:

Notes/Comments (optional):

CONFIRMATION:

By signing below, the recipient confirms that:

1. The equipment described above was delivered to the address specified.

2. The equipment was received in the condition described.

3. The quantity and description of equipment is accurate.

4. The recipient accepts responsibility for the equipment from this point forward.

Recipient signature confirms delivery and acceptance:

RECIPIENT'S SIGNATURE:

Click to Sign

DATE:

PRINTED NAME: