Form 6 SERPIC Order Form

SERPIC Order Form
SERPIC is the parts identification program maintained by DEUTZ Corporation AG. Every distributor and dealer location will need access to SERPIC to perform work duties on a daily basis. This access is distributed through a single sign-on platform. Deutz is currently only authorizing (1) license per location. Please provide the name of the person that will be recieving this access.
Purpose of SERPIC Request*

Dealer Account Setup
DEUTZ Business Type

DistributorCC3/CC2 Dealer
Bill to Distributor/Direct Dealer
Bill to GPA
PO for replacement Disk
Date*

MonthDayYear
Date
GPA Number*
Business Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Manager Submitting Request*

First NameLast Name
Manager's Email*
example@example.com
Manager's Phone*

Area CodePhone Number
Applicant requesting access to SERPIC

*Multiple accounts may result in additional fees *
Applicant #1 Name*

First NameLast Name
Applicant #1 Email*
example@example.com
Applicant #2 Name

First NameLast Name
Applicant #2 Email
example@example.com
IT Phone Number*

Area CodePhone Number
Reason for requesting a replacement disk
Requester's Signature Authorizing PO

Clear
Should be Empty: