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Megger Test Request Form - 2010

The following company and/or individual, as indicated on this form, is requesting Teeter Engineering Group, PA conduct a megger test at the location indicated on this form. Teeter Engineering Group, PA will be compensated for its time invested on the megger test and writing a report of test at the following rates: Megger Testing Time and Travel: Travel expenses: Report: $ 95.00 per man hour $ 0.55 per mile $ 400.00

Additional Engineering Services mutually agreed on in writing will be at an hourly rate as follows: Engineering: Testing: CAD/Drafting: $ 140.00 per hour $ 95.00 per hour $ 75.00 per hour

There is a $400.00 deposit required before tests are performed due to contractors not paying invoices in a timely manner. The remainder of services will be invoiced upon completion of written report. If the project is abandoned or if this agreement is terminated through no fault of TEG, compensation shall be paid to TEG for all services performed prior to written notification of such suspension. Payment will be considered past due if not paid in full within thirty (30) days of our invoice date. Past due accounts are subject to a finance charge of 1.5% per month, 18% annually. Company and/or individual requesting megger test will be liable for any collection agency expenses incurred by TEG for failure to pay invoice in a timely manner in addition to invoice amount. Company Requesting Test:

Name: Address: Phone No.:

Test Location:

Name: Address: Phone No.:

Acceptance of Request Form Agreement:

Signature

Date

* By signing above you agree that Teeter Engineering Group, PA will not be responsible for any damages caused to any equipment due to not complying with preparation checklist.

4059 Yancey Road · Suite A · Charlotte, NC 28217 Phone No. (704) 376-2999 Fax No. (704) 376-3999

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