Clyde Equipment (Pacific) Ltd

Service Request Form

CLYDE EQUIPMENT (PACIFIC) L.T.D

Fax this form duly filled to : Fax No. (679) 337 0431 (Suva), (679) 666 3153 (Lautoka),
or
Send Email to ...... : salessuva@clydepac.com (Suva), salesltka@clydepac.com (Lautoka)

Date of Request:

Customer Registration Number:

Please get registered if you have not done it so far.

If Customer Registration No. is mentioned above no need to fill information marked 0 below :

Company Name:

Address:

Phone (With STD Code):

Fax (With STD Code):

E-Mail:

Contact Person:

Designation & Department:

Type of Machines :

Make :

Model :

Serial No :

Nature of Problem (Please Describe) :

Please Select Status of Machines:
(Tick the correct status)

Warranty Out of Warranty and in AMC Out of Warranty and No AMC

Please call us for our proposal for Annual Maintenance Contract (AMC) if Warranty Period is over

Name of Person Reporting Problem :