PMTS Ltd.

SERVICE REQUEST FAX FORM

Fax: (780) 489-1503

(Print out this form and fill it out please)


To service you better we are asking all of our customers to please fill out this form and fax it to Precision Machine Tool Service Ltd. Department. A Purchase Order Number and an Authorized Signature is required.

Date: (DD/MM/YY) ____/____/____
Company: ______________________________________________________
Address: ______________________________________________________
City: ______________________________________________________
Province/State: _____________________________
Postal Code: _______________________
Contact: 1st ______________________________________________________
Contact: 2nd ______________________________________________________
Phone: ___________________________
Fax: ___________________________
PO #: ______________________________________________________
Type of Machine: ______________________________________________________
Manufacturer ______________________________________________________
Serial #: ________________________________________
Model #: ________________________________________
Problem:

__________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________

Signature: __________________________