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*

ResidentialCommercial
Delivery Specifications*

Liftgate RequiredDock Access
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?*

YesNo
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?*

YesNo
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?*

YesNo
Estimated total usage of the tool / machine.*
Number of hours
Was the operator trained for the usage of the equipment?*

YesNo
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?*

YesNo
Which Company?
Contact name
Person you spoke with.
Has repair been attempted already?*

YesNo
If yes, what was attempted?
Other remarks
Additional description of the issue.
Attach pictures of fault / equipment*

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EQUIPMENT SERVICE REQUEST FORM

Contact Information

Product Details

Reason for Service Request