Equipment Repair Request Form

Equipment Repair Request Form
Request Date
MonthDayYear
Date
Customer Information
Name
First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Equipment Information
List of Equipment
Model/Part No. Item Description Quantity Problem Description
1
2
3
4
5
6
7
8
9
Upload photos of the equipment that needs repair
Cancelof
Was the equipment listed above been repaired for the same issue?
YesNo
Was the issue caused by accidental damage like water spill, equipment was dropped?
YesNo
Payment method
Do you have any special instructions?
Notes and Reminders
Once we receive this form submission, we'll call you over the phone to make sure that we have the correct information.
Depending on your location, we can send someone to pick up the equipment. You can also send it to our repair center using the waybill that we'll provide.
We do not repair accidental damage like a liquid spill or if the equipment was dropped.
Depending on the broken equipment, the repair will take 10-20 business days. Once repaired, we'll call you for assurance, and then we'll provide an approximate turn around time.
Should be Empty:

Customer Information