Depot / On-Site Equipment
Repair Request Form
Depot / On-Site Request Form
First Name:
Last Name:
Daytime Phone:
Fax:
Company:
E-mail:
Street Address:
Street Address 2:
City:
State:
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UTAH
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ONTARIO
Zip Code:
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Will the Repair be Depot or On-Site?
Depot:
On-Site:
Please indicate the equipment you wish to have repaired
Manufacturer :
Part # :
Quantity :
If broken equipment, what was the situation that led to the equipment breaking down?
Do you currently have a service agreement with American Barcode on any of your data collection or printing products?
YES:
NO:
In what type of environment is this equipment used? (in a warehouse, outside, etc.):
If label or card printer, what type of media (labels/ribbon) and printhead is used?
What is the best way our Service Representative can reach you?
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