Page 13 - BRITELITE PRESENTER FEB19

Standard Satisfaction Note:

Customer Delivery/Satisfaction Note

Supplier 2 Apex View, Leeds, LS11 9BH
Name : Tel: 0344 3755515
Fax: 0113 3801158
Email: paymentrequests@hitachicapital.co.uk
Number:

Agreement Authorisation Number:

Customer

Title: Mr/Mrs/Miss/Ms.Other Forenames: Surname:
Address:

Postcode:
Telephone Number: Email Address:
Third Party Declaration (to be completed by the agreement signatory with nominated person present)
NOTE: This declaration allows you to nominate a Third Party (a trusted person) to sign this Customer Satisfaction Note on completion of delivery and/or installation
of the goods/services if you can't be there in person. This is to be completed before delivery or installation.
I, the agreement signatory, give my authority to the person named below to sign this Satisfaction Note on my behalf to confirm that I am
satisfied with the delivery and/or installation of the goods/services described below and I authorise Hitachi Personal Finance to release the
amount of credit to the retailer on gaining said authorised signature

Name of Nominated Person:
Signature of Nominated Person:
Signature of the agreement signatory:

Customer Declaration
(To be completed below by the agreement signatory or the Third Party authorised above)
Description of Goods:
Delivery and
Delivery Installation
I can confirm that the goods and installation where applicable are to my satisfaction and I authorise Hitachi Personal Finance to release the amount of credit to the
retailer
Signed: Date:
Print Name:

Hitachi Personal Finance is a division of Hitachi Capital (UK) PLC
Hitachi Capital (UK) PLC is authorised and regulated by the Financial Conduct Authority

This document is for internal purposes and not to be shown to customers