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* Denotes a required field.
** Under Equipment Information, either the Equipment ID # or the Serial # is required.
Service Requester Contact Details
*Name:
*Email:
*Company:
*Phone:
Comments:
Service Contact Details -
Leave Blank If The Same
Name:
Phone:
Equipment Information
**Equipment ID (EID):
**Serial #:
**Equipment Status:
Select Status
Equipment is not working
Equipment is working
**Problem Description:
Select Problem
Accessory
Cannot transmit/receive faxes
Error Code
Install/Deinstall/Retrofit
Jamming
No Power/Down
Noise/Odor
Post Copy/Print Quality
Preventative Maintenence
Other
Comments:
Equipment Location
*Address 1:
Address 2:
*City:
*State
*Zip:
Comments:
Service Coverage
Contract
T & M (Enter PO#)
Manufactures Warranty
Other - Please Explain
Service Notification
Please check if you want a dispatcher to confirm the service request or give an estimated time of arrival
