INTEL CAPITAL EQUIPMENT ACCEPTANCE CERTIFICATE (To be completed by supplier representative.) This is to certify that the following capital equipment meets the final acceptance criteria as specified in the Intel Purchase Specification. SHIPMENT INFORMATION Equipment Description Model Mfg. No. (serial number) Factory Tool I.D. # ________________________________________________ Tool Locator # (if known) ________________________________________________ Intel Purchase Order # Manufacturer

INTEL CAPITAL EQUIPMENT ACCEPTANCE CERTIFICATE
(To be completed by supplier representative.)
This is to certify that the following capital equipment meets the final acceptance criteria as
specified in the Intel Purchase Specification.
SHIPMENT INFORMATION
Equipment Description
Model Mfg. No. (serial number)
Factory Tool I.D. # ________________________________________________
Tool Locator # (if known) ________________________________________________
Intel Purchase Order #
Manufacturer

INTEL CAPITAL EQUIPMENT ACCEPTANCE CERTIFICATE (To be completed by supplier representative.) This is to certify that the following capital equipment meets the final acceptance criteria as specified in the Intel Purchase Specification. SHIPMENT INFORMATION Equipment Description Model Mfg. No. (serial number) Factory Tool I.D. # ________________________________________________ Tool Locator # (if known) ________________________________________________ Intel Purchase Order # Manufacturer

INVOICE INFORMATION Original Invoice Number Original Invoice Date Month Day Year Dollar Amount Due $_______________________________________________ (final percentage payment due; generally 20%) ACCEPTANCE COMPLETE Date of Acceptance Month Day Year Intel Signature (Intel Engineer or IQ signature) Print Name/Title ACCEPTANCE NOT YET COMPLETE, BUT FINAL PAYMENT BEING MADE _______Intel... representative, check here and complete this section if final acceptance criteria have not yet been met, but final payment is being made, per contract payment terms. Release of final payment under this provision does not release either party of their responsibilities provided for in other sections of the Purchase Agreement and Specification. Intel Signature (Intel Engineer or IQ signature) Date Month Day Year ______________________________________________________________________________ Supplier Service Engineer ________________________________________________ (signature) Print Name/Title Supplier Instructions Send completed form only to e-mail account sap_ap-usa_capital@mail.intel.com. Account payable department will review and release the final payment. Read the full INTEL CAPITAL EQUIPMENT ACCEPTANCE CERTIFICATE (To be completed by supplier representative.) This is to certify that the following capital equipment meets the final acceptance criteria as specified in the Intel Purchase Specification. SHIPMENT INFORMATION Equipment Description Model Mfg. No. (serial number) Factory Tool I.D. # ________________________________________________ Tool Locator # (if known) ________________________________________________ Intel Purchase Order # Manufacturer.