Centre State Computer Maintenance

ONSITE SERVICE REQUEST FORM

Please fill out the details of the work required in the form below. (Required feilds are marked with a red asterik).
Alternativley you can fill download and fill out a PDF version of this form here and then email it to logajob@cscm.com.au or Fax it to 07 4926 1901

CUSTOMER DETAILS

COMPANY

ABN

ADDRESS *

SUBURB *

STATE *

POST CODE

CONTACT

POSITION

PHONE *

MOBILE

FAX

BILLING DETAILS (IF DIFFERENT FROM ABOVE)

PURCHASE ORDER NO

CONTACT

ADDRESS

SUBURB

STATE

PHONE

SERVICE TYPE *

WARRANTY

IF YES WITH WHO

EQUIPMENT BRAND *

MODEL NO *

SERIAL NO

FAULT DETAILS *

SUPPORT EQUIPMENT

CONDITION OF MACHINE

CONDITION OF MACHINE

Damage to machine

I/we are happy to pay the minimum $74.25inc (for onsite repairs), for providing a quotation; and/or all costs incurred in repairing my equipment (labour & travel), regardless of its acceptance or rejection by me/us. (Please enter the letters shown below and then click the "Submit" button to accept the above terms and to submit your "Onsite Service Request")

Type the characters you see in the picture below

Centre State Computer Maintenance

ONSITE SERVICE REQUEST FORM

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