Maintenance Request Form

Gym Equipment Maintenance Request Form

Please fill out the following details to allows us to assist with your maintenance needs.
CUSTOMER DETAILS
Business Name
Contact Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: 0000000000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this the best contact person for onsite questions
Are you happy for the technician to contact you directly?

Maintenance to be completed
Maintenance to complete (please include order numbers for each item and for machines, there should be a serial number located on a white sticker around the bottom of the machine, please include if known. Within the notes section include any known issues that require maintenance).
Please upload photos of all equipment that requires servicing. Please include additional close-up photos or videos of specific servicing (e.g., fixing a squeaky noise). This will ensure the technician is prepared for servicing.
Please include additional work that is needed during servicing (e.g., Moving a machine from point A to point B).

By submitting this form, I understand that the information provided will be used to generate an accurate installation quote. Any extra charges or requests for additional work outside of this quote will be billed to the customer.
Customer Signature
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Hour Minutes
Should be Empty:

Gym Equipment Maintenance Request Form