Free maintenance request form 27Free maintenance request form 27
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MACHINE REPAIR REQUEST FORM
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*For Customer Only
DATE:
COMPANY NAME:
ADDRESS:
CONTACT PERSON:

TEL#
SERIAL#

MODEL#
MACHINE DETAILS:

* Please attach images to this form when you send it.

*For Machine Workshop Only

EXAMINATION INFORMATION
DATE EXAMINED:
PICTURE TAKEN

YES

NO

PARTS TO BE ORDER

YES

NO

ESTIMATED TIME TO FIX
ESTIMATED PRICE FOR REPAIR

EXAMINE AND REPORT
CUSTOMER DAMAGE

(CHECK ONE)
SHIPPING DAMAGE

FACTORY DAMAGE

REPAIR INFORMATION
DATE OF REPAIR
REPAIR BY WHOM
TOTAL CHARGE FOR REPAIR:

PARTS USED

EXPLANATION OF REPAIRS

COMMENTS

TIME FOR REPAIR