Purchase Installation Confirmation - Customer Purchase Installation Confirmation - Customer Personal Info Title * Mr. Mrs. Ms. Dr. Full Name: * ID Number: * Cell Number: * Email Address: * VAT Number Street Address / Suburb: * Apartment, suite etc: City: * State / Province: * ZIP / Postal Code: Sales Info Unit Description * Delivery Date * Agreement The Purchaser confirms the Schedule, and the payment terms are complete, and the clauses of the Master Sale Agreement have been read and agreed prior to the signature of the Agreement. ACCEPTANCE CERTIFICATE The Purchaser irrevocably declares to Aqua Therma that the Solar Geyser Units described in the Master Sale Agreement has/have: a) Been delivered and installed in accordance with the Agreement; b) Been correctly recorded in the Schedule above and warrants that the particulars recorded above in relation to the Solar Geyser Unit corresponds with the Solar Geyser Unit delivered; c) Been purchased by Aqua Therma at the Purchaser’s special instance and request, and Aqua Therma is hereby indemnified against any claims that may be made against Aqua Therma, that the Purchaser may sustain arising out of or in relation to the purchase by Aqua Therma of the Solar Geyser Unit from the supplier. Consent * Yes, I agree with the privacy policy and terms and conditions. Signature * signature keyboard Clear If you are human, leave this field blank. Submit Start Over