ELECTRIX USA, INC.

Date:                       Customer:               Attn:                        Equipment Type:    MFG:                       HP:                            RPM:              Frame:                      Model#:        Serial # :                   Volts:              AMPS:                       W.O.#:           WORK SCOPE DISASSEMBLE, INSPECT ELECTRICALLY AND MECHANICALLY STEAM CLEAN PARTS AND WINDING BAKE DRY WINDING MANUFACTURE FORM TYPE COILS REWIND (STATOR, ROTOR, FIELDS, ARMATURE) DYNAMIC BALANCE (ROTOR, ARMATURE) DIP AND BAKE WINDINGS V.P.I. WITH DUROLIFE EXPOSY COAT EXTERIOR AND INTERIOR WITH ANTI-CORROSIVE PRIMER REPLACE BEARINGS REPLACE BRUSHES REPLACE CAPACITORS REPLACE SEALS TURN AND UNDERCUT COMMUTATOR MACHINE AND RE-SLEEVE BEARING HOUSING #1 MACHINE AND RE-SLEEVE BEARING HOUSING #2 MACHINE BEARING JOURNAL #1 MACHINE BEARING JOURNAL #2 ASSEMBLE, CLEAN, AND PAINT TEST AT RATED VOLTAGE LOAD TEST PICK UP AND DELIVERY                                                                               OVERTIME:    YES    NO                                                                                        *PRICE:                                                                                                   DELIVERY:                                                                                              SIGNATURE:          (*SALES TAX, IF APPLICABLE, IS ADDITIONAL TO QUOTED PRICE)   IF YOU HAVE ANY FURTHER QUESTIONS, PLEASE CONTACT THE UNDERSIGNED. Enter your comments in the space provided below: Please contact me as soon as possible regarding this matter.