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Installation & Repair Reference Sheet

Corporate Office:
220 Webbs Mill Road, Floyd VA 24091
Phone: (800) 941.0426 or (540) 745.2111
DCJS # 11-9804
Customer Name: CDG Task ID:
Customer Phone: Arrival Time:
Technician Name: Date of Service:

Pre-Service Acceptance:

I have been fully informed of how the Citizens service will be installed or repaired. I hereby accept the proposed Installation or Repair Plan and Cost Summary (if applicable). I understand that any estimated cost outlined in this document are good faith estimates based on the anticipated time & materials needed to complete the task. I understand that the estimate does not include applicable tax and the cost may vary due to unforeseen obstacles or issues encountered during the installation or repair. I hereby agree to pay for all charges incurred during this installation or repair. By signing below, I am accepting financial obligation and authorizing the Citizens Technician(s) to begin work.

Installation Plan


Post-Service/Cost Acceptance:

The Citizens Technician has reviewed the completed installation or repair, provided ample education on new equipment and cleaned up all work areas to my satisfaction. All Citizens services have been demonstrated and are working properly and I approve the quality of work and level of service. By signing below, I hereby accept the installation or repair as complete and satisfactory and agree to pay for all associated cost.