Service Request Form

Company NameCompany Contact

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Do you have a service contract*

YesNo

I am requesting service on:*

Describe the issue you are having.*

The more details we have, The better it is to understand your unique situation

Repair My System:

A One time Trip Charge Of $250 for up to 50 miles. Additional Fees for trips over 50 miles. Includes the first 15 minutes on site then the rate is $185 per hour after. Materials are based on what parts or materials that are required to complete the repair. ( This is a pre authorization to repair the system ASAP )

Diagnosis:

A One time Trip Charge Of $250 for up to 50 miles. Additional Fees for trips over 50 miles. Includes the first 15 minutes on site then the rate is $185 per hour after. This is to diagnose your issue and create an estimate to detail out the issue and the repairs needed for review and approval by the customer before any repairs are made. The customer will receive the quote for a signature approval and invoice for any required deposits prior to any work commencing

Phone Support:

A Technician will call you at a Rate of $185 per hour at an arranged time to go over your Issue with you. This could help troubleshoot any Programming or simple issues that the customer may feel they can correct with help from a Technician without the need for a Tech to go to the site.

Emergency Service:

One time Trip Charge Of $250 for up to 50 miles. Additional Fees for trips over 50 miles. This is a portal to portal Service call with 24 hour or less response time. Portal to portal means time starts when the truck leaves its home portal and stops when it arrives back to its home portal. The Emergency Service rate is $375 per hour with a 4 hour minimum charge.

All Service or Maintenance contracts are billed per the terms of the Service or Maintenance Agreement

Type of service requested*

Repair My System. Done on a Time and Materials BasisDiagnosis my sysyem. Done on a Time Basis with Estimate to RepairPhone support. Done on a Phone Support Time Rate BasisEmergency Service. Done on a Portal to Portal Emergency Rate Basis

Signature*

Service Request Form

Service Call Price List

By submitting this request form you agree to the terms set above for the type of service requested.