Service Booking Sheet
Customer number (*)
Customer name
Contact person
Contact phone number
Contact email
Purchase order number (*)
(15 char max)
Date Preferred
Equipment Serial number (*)
Please Select
How is the equipment coming to Glasscorp?
Please Select
Glasscorp to arrange pickup via transport
Glasscorp to pickup by truck
Customer will drop it to Glasscorp
Customer will arrange delivery via transport
Technician will service on site
Equipment Site address
Is a Loan Lifter required?
Yes
No
What area is the Lifter being used in?
Reason for booking (*)
multiple allowed
click to select and deselect
Annual Service
Repair
Fault
IF FAULT CANNOT BE REPLICATED
Contact Person (*)
Contact phone number (*)
Fault inspection
1 fault per line
Additional Comments
Attache Images
(4 maximum, 2MB per image)
CLICK TO SUBMIT FORM
Booking sent. We will be in touch shortly.
Do you wish to send another ?
Yes
No
