Warranty Repair

Company Name
Contact Person
Phone
Mobile
Email
Address of Equipment
Building No.
Room No.
Equipment Serial No.
Equipment Model No.
Equipment Description

 

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Invoice Number
Reason for Service
Service by (specify date)

 

Service Required *

NOTE: All on site services will incur a call-out fee and labour charges at the current rate.

On Site Service (within 7 days)Return to Factory •(at customer's expense)•

Payment Declaration *

I am authorised to request the service on the above equipment and will by paying by:

Credit CardAccount

Contamination Declaration *

To the best of my knowledge the equipment does not contain any asbestos or hazardous chemicals.

Name
Date
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