EQUIPMENT SERVICE REQUEST FORM

EQUIPMENT SERVICE REQUEST FORM
Contact Information
APS Point of Contact
Customer Company
Company Name
Contact Name

First NameLast Name
Phone Number

Country CodeArea CodePhone Number
Email
example@example.com
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Address Type
Delivery Specifications
Special Delivery Instructions
Contact name, number, delivery requirements, etc.
Hours of operation for delivery
Billing Contact

First NameLast Name
Billing Email
example@example.com
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reseller
Company equipment was purchased from.
Reseller Sales Person

First NameLast Name
Was this purchased within the past 12 months?
Date of Purchase

MonthDayYear
Date
Order Number
Reseller order number
Proof of Purchase

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Product Details
Type of Equipment
Raptor Cutter, Dancutter, Speedylight, etc.
Serial Number
Serial number listed on equipment
What was the power source for the equipment when you experienced the problem?
i.e. Generator type, 110v, etc.
Other products that have been affected (if any)
Reason for Service Request
Describe the fault / what symptoms are being experienced?

(Noise, shake, overheating, cable twisting, etc.)0/500
Is this a recurring problem?
How many times has this problem occurred?
Describe the job being performed when the fault appeared.
i.e. Liner removal, coating, etc.
Which other products (or other supporting products such as a generator) were used during the job?
How long was the tool used for before the fault appeared?
i.e. 30 mins, 3 hours, etc.
Has the tool or machine been used successfully before?
Estimated total usage of the tool / machine.
Number of hours
Was the operator trained for the usage of the equipment?
If so, by which company?
Date training was completed on.

MonthDayYear
Date
Have you contacted your reseller or the manufacturer about the same problem before?
Which Company?
Contact name
Person you spoke with.
Has repair been attempted already?
If yes, what was attempted?
Other remarks
Additional description of the issue.
Attach pictures of fault / equipment

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Payment Acknowledgment
Should be Empty:

EQUIPMENT SERVICE REQUEST FORM

Contact Information

Product Details

Reason for Service Request