Prudential Cleanroom CV Representative Action
Date
*
YYYY dash MM dash DD
公司
*
Prudential Representative
*
Service Agreement Signature Responsibility
SRA/PO Expiration date
MM slash DD slash YYYY
Date of last CV
MM slash DD slash YYYY
Program Type
Rental
COG
Both
Additional Products / Services / Locations
Additional products or services we can provide service for? (please list)
Is customer currently using Prudential Industrial Services?
yes
no
Current Provider
List of other locations to offer services. Include DBA, Phone, Address, Contact and Need (Industrial, Cleanroom, National, Direct Sale)
Is Customers A/R status current? Action Taken to resolve? If current thank customer.
A/R
A/R Initial
Check this box to initial this has been completed
A/R Date Corrected
MM slash DD slash YYYY
Sales & Service action needed
S&S Action
S&S Initial
Check this box to initial this has been completed
S&S Date Corrected
MM slash DD slash YYYY
Production Department action needed
PD Action
PD Initial
Check this box to initial this has been completed
PD Date Corrected
MM slash DD slash YYYY
DAY
*
PLANT
*
00 - Corporate
02 - Riverside
03 - Chula Vista
04 - Carson
05 - Los Angeles
06 - Irvine
08 - Fresno
09 - Milpitas
10 - Milpitas Cleanroom
12 - Indio
13 - Vista
15 - Los Angeles
17 - Moorpark
18 - West Sacramento
21 - Tucson
22 - Phoenix
23 - Mesa
26 - Prescott
30 - Denver
32 - Las Vegas
45 - Albuquerque
50 - Austin
51 - El Paso
54 - St. Louis
55 - San Antonio
60 - Portland
70 - Richmond
71 - Nashua Cleanroom
73 - Nashua
80 - Colonial Heights
81 - Beckley
83 - Greenville
85 - Atlanta
路线
*
Please enter a number less than or equal to
999
.
ACCOUNT #
*
Please enter a number less than or equal to
999
.
WEEKLY VOLUME
*
Please enter a number greater than or equal to
1
.
CUSTOMER #
*
Please enter a number greater than or equal to
1
.
Signature for desktop users without touchscreen
Check the box to sign without actual signature (for desktop users without touchscreen)
保诚签名
*
For Admin Use:
SLX ID
REPORT_REQUESTID
Comments
This field is for validation purposes and should be left unchanged.
Form 10118web, Rev. 08/14/18
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