MAIN PAGE | CREDIT INSTALL CHARGE ------> Must be approved before escalating credit / IF CHARGE IS APPLICABLE THIS IS COURTESY

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APPROVED BY
ACCT#
CHARGE	CHOOSE CHARGE INSTALL $46.95 PORT FEE $40.00
BILLED ON
REASON	CHOOSE REASON NOT INSTALLED NEVER PORTED PORT UNSUCCESSFULL INCOMPLETE WRLN INCOMPLETE ENH WRLN POOR INSTALL MULT ATTEMPTS FAILED PORT NOT COMP IN NPAC BILLED IN ERROR BILLED 2X FOR SAME INSTALL CR FOR REPEAT VISIT ONE TIME COURTESY UNAWARE OF FEE DISSAT WITH WORKMANSHIP
INPUT CODE
DOCUMENTED IN REMEDY?	SELECT YES NO
SUP IN THE OFFICE?	SELECT YES NO
CREDIT ALREADY GIVEN? (CD- F9, 5, 11)	SELECT YES NO
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