Customer-Supplied Materials Acknowledgment
A one-page form for jobs where the customer buys the fixture, part or equipment. It records what was supplied, the labor-only price, who warrants what, and what happens if the item turns out to be the wrong one. Rules vary by state, so check your state agency before relying on any warranty wording.
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Generate PDF →Template only, not legal advice. Have an attorney licensed in your state review this template before using it with clients.
What’s in this template
Customer-Supplied Materials Acknowledgment
Template notice. This is a general-purpose form. Warranty, disclosure and consumer-protection rules vary by state and by trade. Check with your state licensing or consumer-protection agency before relying on the wording.
1. Job
- Provider: Provider Business Name
- Provider phone: Provider Phone
- Client: Client Name
- Client phone: Client Phone
- Service address: Service Address
- Job or quote no.: Job or Quote No.
- Scheduled date: Scheduled Date
2. Installation Work
Installation Work
3. Items Supplied by the Client
List each item the client is providing. Write the brand and model exactly as they appear on the box or label.
| Item | Brand and model | Qty | Bought from | Condition on arrival |
|---|---|---|---|---|
6 blank rows on the printed form
4. Price
- Labor-only price: Labor-Only Price
- Charge if an item cannot be installed: Charge If the Item Cannot Be Installed
The price above covers Provider Business Name's labor to install the items listed. It does not include the items themselves, and the provider adds no markup because the client bought them.
5. Who Stands Behind What
Installation warranty: Installation Warranty. Provider Business Name will correct a defect in its own installation work during that period. The client understands that the items listed in section 3 were not supplied by the provider. Any warranty on those items is between the client and the manufacturer or seller, and the provider is not responsible for a defect in the items themselves or for the cost of replacing them.
6. If an Item Cannot Be Installed
The provider will check each item on site before installing it. The provider may decline to install any item it believes is the wrong size or type, damaged, unsafe, or unsuited to the job, and will tell the client why. If an item cannot be installed, the client may choose to get a suitable item and reschedule, or to have the provider supply one at the provider's usual price. The charge in section 4 applies to a visit that cannot be completed because of an item the client supplied.
7. Signatures
The client has read this form, confirms the items in section 3 are the items to be installed, and agrees to the price and terms above.
Client signature line
Provider signature line
Customer-supplied materials form questions, answered
What is a customer-supplied materials form?
A short sheet the customer signs before you install something they bought themselves. It lists the item, states that you are charging for labor only, says who stands behind the installation and who stands behind the product, and says what happens if the item turns out to be the wrong one.
Who warranties a customer-supplied part?
Normally you stand behind your installation work and the manufacturer's warranty, if there is one, covers the product. The form puts that split in writing so a failed part is not argued as a workmanship problem later. Warranty rules vary by state, so check with your state agency before relying on the wording.
Can I refuse to install something the customer bought?
The form says you may. It reserves your right to decline any item you believe is the wrong size or type, damaged, unsafe, or not suited to the job. Put it in writing before the visit so the customer knows the install depends on the item passing your check on site.
Should I charge for a trip if the item is wrong?
That is your call. The form has a line for the amount so the customer agrees to it before you arrive. If you charge one, set it to cover the visit you cannot use, and keep it the same for every customer.
Do I need an account to use this form?
No. Download the blank form and print it, or fill in the job details online and download a PDF. Neither needs an account.
Collect the signature before you load the van
In EosLog you can attach this kind of form to the job and have the customer sign it on their phone, so the labor-only terms are agreed before the visit and stored with the job.