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Get CA Form 720-21 2008

00 Office 877 457-6482 Fax 213 382-2501 RECORD OF CONTINUITY BRAZER QUALIFICATION We wish to use provision QB-322 a of the ASME Section IX Boiler and Pressure Vessel Code. Renewal of Qualification Renewal of qualification of the performance qualification is required when a brazer or brazing operator has not used the specific brazing process for a period of 6 months or more or there is a specific reason to question his ability to make brazes that meet the specification. BRAZER NAME BRAZER STREET ADDRESS CITY STATE AND ZIP SOCIAL SECURITY or CARD I. D. XXX- - RESIDENCE PHONE / ID CELLULAR PHONE This individual has successfully brazed using the procedure set forth by National ITC Corporation BPS 98-101 and has not exceeded a period of six 6 months without making a braze to this procedure. DATE OF MOST RECENT BRAZEMENT must be on or before expiration date Sincerely Print Name of Contractor or authorized representative Signature of Contractor or authorized representative Individual that witnessed brazement Title of signer Name of Company Method of Payment Total Amount Enclosed Check Money Order Visa Credit Card No Master Card Expiration Date On the back side of your credit card write the last sequence of three or four digits Credit Card Billing Address Zip Code Signature Signature as shown on credit card Form 720-21Rev 02-18-08 record of continuity. TO BE ON CONTRACTOR LETTERHEAD Send to National ITC Corporation 501 Shatto Place Suite 201 Los Angeles CA 90020 FEE 33. D. XXX- - RESIDENCE PHONE / ID CELLULAR PHONE This individual has successfully brazed using the procedure set forth by National ITC Corporation BPS 98-101 and has not exceeded a period of six 6 months without making a braze to this procedure. DATE OF MOST RECENT BRAZEMENT must be on or before expiration date Sincerely Print Name of Contractor or authorized representative Signature of Contractor or authorized representative Individual that witnessed brazement Title of signer Name of Company Method of Payment Total Amount Enclosed Check Money Order Visa Credit Card No Master Card Expiration Date On the back side of your credit card write the last sequence of three or four digits Credit Card Billing Address Zip Code Signature Signature as shown on credit card Form 720-21Rev 02-18-08 record of continuity. D. XXX- - RESIDENCE PHONE / ID CELLULAR PHONE This individual has successfully brazed using the procedure set forth by National ITC Corporation BPS 98-101 and has not exceeded a period of six 6 months without making a braze to this procedure. DATE OF MOST RECENT BRAZEMENT must be on or before expiration date Sincerely Print Name of Contractor or authorized representative Signature of Contractor or authorized representative Individual that witnessed brazement Title of signer Name of Company Method of Payment Total Amount Enclosed Check Money Order Visa Credit Card No Master Card Expiration Date On the back side of your credit card write the last sequence of three or four digits Credit Card Billing Address Zip Code Signature Signature as shown on credit card Form 720-21Rev 02-18-08 record of continuity. .

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  • IX
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