Warning: SOME PRODUCTS WE SELL MAY CONTAIN ONE OR MORE CHEMICALS KNOWN TO THE STATE OF CALIFORNIA TO CAUSE CANCER, BIRTH DEFECTS OR REPRODUCTIVE HARM. For more information please visit https://oehha.ca.gov/proposition-65

( * ) - a required field

DATE: *		TIME:
CUSTOMER NAME: *		ACCOUNT #:
JOB (NAME and ADDRESS): *
ATTN :		PHONE #: *
DATE NEEDED:		FAX #:

* IF THIS RELEASE HAS BEEN REQUESTED BY ANY OF THE FOLLOWING VOUCHER COMPANY PLEASE MARK:
B.D.I. N.B.C.		OTHER:
ATTN:		FAX #:

TYPE OF RELEASES : ( PLEASE MARK ):
# 1 CONDITIONAL PROGRESS # 2 UNCONDITIONAL PROGRESS # 3 CONDITIONAL FINAL # 4 UNCONDITIONAL FINAL
THROUGH DATE :	(REQUIRED FOR #1 & #2)

NOTE: If you are requesting a conditional progress AND/OR a conditional final AND the balance is zero (0), you will be issued the appropriate UNCONDITIONAL release form.

IF THE JOB IS NEW AND YOU HAVE NOT SUBMITTED PRELIMINARY INFORMATION PLEASE FAX OVER WITH THE RELEASE REQUEST. (PRELIMINARY INFORMATION IS REQUIRED TO COMPLETE ALL RELEASE REQUESTS)

DO YOU NEED THE MAKER OF THE CHECK TO BE FILLED IN ON RELEASE FORM ?
Yes No
IF YES, PLEASE GIVE US THE NAME:

DOES YOUR COMPANY NEED TO BE A PAYEE ON THE CHECK ( TWO PARTY CHECK)
Yes No
DOES YOUR RELEASE NEED TO BE NOTARIZED?
Yes No

Please keep this form for future reference. If you need a new form, we will issue a new form.

RENO HARDWARE RELEASE DEPARTMENT FAX: ( 951 ) 248 - 1212 EMAIL: Release@RenoHardware.com 24 HOURS A DAY 7 DAYS A WEEK REV 6/20/2000

Release Request Form