Hotel & Restaurant Supply
Suppliers/Designers to the Food Service Industry
REQUEST FOR SERVICE:
Who is filling out this form?
*
Customer
H&R Sales Staff
Date
*
-
Month
-
Day
Year
Date
Customer
*
Business Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
First Contact Name
*
First Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
First Contact Email
example@example.com
Second Contact Name
Second Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Second Contact Email
example@example.com
H&R Salesperson / Project Manager
H&R Branch Used
*
Please Select
Gulfport
Jackson
Memphis
Meridian
Nashville
New Orleans
Tuscaloosa
Manufacturer
*
Model #
*
Serial #
*
Invoice #
Date Invoiced
-
Month
-
Day
Year
Date
Has a start-up been performed on this unit?
*
Please Select
Yes
No
N/A
Description of Problem
Please upload any photos for files that may be relevant.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Has any troubleshooting been performed?
Yes
No
When was this troubleshooting attempted?
*
-
Month
-
Day
Year
Date
Describe attempted troubleshooting.
*
Is the Item Under Warranty?
Please Select
Yes
No
Unsure
Preview PDF
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