- End User of cable products _________________________________________________________________
(Organization where cable is installed)

- Corporate address of end user: ______________________________________________________________

_______________________________________________________________________________________

- Project Manager: _________________________________________________________________________

- Building/location of installation: _____________________________________________________________

_______________________________________________________________________________________

- Dates between which the cable products were installed _____________________to_____________________

- Certified Installer: ________________________________________________________________________

- Address: ______________________________________________________________________________

_______________________________________________________________________________________

- Project name, if any: ____________________________ Project Supervisor: ___________________________

- OCC cable purchased from (Seller): _______________________ Seller's Purchase Order #: ________________

- Seller's Address: ___________________________________ Purchase Order Date: _____________________

- Cable Series installed: _____________________________________________________________________
(eg. DX12 Plenum)

- Date of Shipment: __________________________ Warranty Expiration Date: _________________________

By: __________________________________________________ date: ________ / _________ / _________
(Signature, Project Manager, Certified Installer)

By: __________________________________________________ date: ________ / _________ / _________
(Signature, Corporate Officer, Optical Cable Corp.)

INSTALLERS/END USER, PLEASE FILL IN ALL INFORMATION ON THIS FORM,
AND RETURN TO OCC FOR APPROVAL AND REGISTRATION OF WARRANTY.

(The following to be assigned by Optical Cable Corporation)