I agree to the terms outlined in "Missouri Pinball Service Conditions".

Signed __________________________________Date_____________________

Contact information:

Machine_____________________________Yr_____Man________Manual__Y__N_

Owner___________________________________Phone_____________________

Address__________________________________Email_____________________

City_____________________________________State_______Zip____________

Est. value____________________Notes__________________________________

Repair:

Problem____________________________________________________________

_____________________________________ Date received _________________

Results of evaluation__________________________________________________

_____________________________________Owner contact__________________

Estimate: Parts_____________ Labor________________Owner Approval________

Date parts ordered____________________Date parts received________________

Actual cost of parts with shipping and handling _____________$________________

Actual number of hours in repair #_________ x ($40 per hr.) = $________________

Total cost of repair__________________________________$________________

Owner contact for pick up___________________Date picked up________________

Notes: