Company Details	*Indicates Mandatory Fields
Company Name
Service Request Details
Name of Person Requesting This Service*
Position Held*
Email Address*
Phone*
Mobile Telephone Number
Purchase Order Number	If out of warranty- Please fax purchase order to 03 9466 7188

Name of Vehicle

Vehicle Make

Vehicle Model

Rego

Description of Problem

Date Required dd/mm/yyyy

Time Required

Street Address

Suburb

State

Contact Person At Job Site

Contact Phone No

1

2

3

4

5

    

Any special comments you wish to add

Terms and Conditions of Sale:- Please read carefully and acknowledge

For any products outside warranty terms, Service Technician Rates are charged at $120 per hour including travelling time for the first hour and $60 per 30 minutes or part thereof afterwards. It is your responsibility to have all vehicles available at the scheduled booked time as a service fee for the first hour will be charged regardless of work done. Job cancellations will not be accepted within 24 hours of the scheduled time. Any warranty service requests booked where vehicles and or devices are not available at the booked time will incur service fees based on waiting times at the rate of $60 per 30 minutes.

If you agree with the terms and conditions of sale please answer YES (type in capital letters)