 |
| Date: |
__________________ |
|
|
| Purchase Order: |
__________________ |
Requisition #: |
__________________ |
| Status: |
_____________ |
Repair Price Quoted: |
_____________ |
_______ |
Quote Needed |
|
| Company: |
__________________ |
Account #: |
__________________ |
| Company Address: |
______________________________________________________ |
| Contact Name: |
______________________________________________________ |
| Phone #: |
(____)____________ |
Fax #: |
(____)____________ |
| Unit Details |
| Quantity Enclosed: |
__________________ |
|
|
| Part #: |
__________________ |
Customer Part #: |
__________________ |
| Serial #: |
______________________________________________________ |
| Description: |
______________________________________________________ |
| Failure Symptoms: |
______________________________________________________ |
| ____________________________________________________________________________ |
| ____________________________________________________________________________ |
| ____________________________________________________________________________ |
| Original Equipment This Unit Came From: |
| Machine Manufacturer: |
__________________ |
Type of Machine: |
__________________ |
| Serial #: |
______________________________________________________ |
| Documentation Enclosed For This Unit: |
| _______ |
Prints |
_______ |
Connection Diagrams |
| _______ |
Programming Instructions |
_______ |
Operating Instructions |
|
| All documentation will be returned with repaired unit. |
| Warranty Repair: |
_____No _____Yes |
|
DELIVERY:
|
| _____Standard 7 - 10 days _____Priority 3 - 5 days*
_____Emergency 24 hours* |
|
SHIP VIA: |
| _____UPS _____Customer Pickup
_____Other_____________________ |
| Special Instructions: _________________________________________________________ |
| _________________________________________________________________________ |