Customer Contact for Service

CONTROL SYSTEM - SERVICE CALL / PHONE SUPPORT
Date

MonthDayYear
Date
Do you have an Active Service Contract with Mercer-Zimmerman?
ACTION ITEM REQUESTED
NOTE: CALL BACK (Phone Support/Evaluation) — SITE VISIT (requires billing contact information be provided)
SYSTEM TYPE NEEDING SERVICE
Hold Ctrl key while clicking to select multiple Systems (if DMX Fixtures or Other is selected, please provide details in the Description of Issue field.)
Service Contract/Project # if available
Will be listed on your Service Contract Proposal
CUSTOMER / JOB NAME
SITE ADDRESS

Street Address

Street Address Line 2

CityState

Zip Code
SITE CITY
SITE STATE
State
SITE ZIP CODE
SITE PHONE NUMBER

Area CodePhone Number
SITE CONTACT

First NameLast Name
SITE CONTACT EMAIL
example@example.com
DESCRIPTION OF ISSUE
Provide a description of your issue(s).
COMPANY NAME (for billing)
BILLING CONTACT (ACCOUNTS PAYABLE)

First NameLast Name
BILLING ADDRESS

Street Address

Street Address Line 2

CityState

Zip Code
BILLING CITY
BILLING STATE
State
BILLING ZIP CODE
BILLING EMAIL
example@example.com
BILLING PHONE NUMBER

Area CodePhone Number
SERVICE REQUEST TO BE EMAILED TO:
example@example.com
Person Submitting Service Request
MERCER-ZIMMERMAN CONTROLS CONTACT NAME

Name of Mercer-Zimmermanyou have been in contact with (If applicable)
Should be Empty:

CONTROL SYSTEM - SERVICE CALL / PHONE SUPPORT