Application
Model
Serial No.
Purchase date
Customer
Address
Contact
Tel
1
．
Maintenance/overhaul
□
Regular maintenance
□
Breakdown:
□
Ultimate pressure insufficient
□
Abnormal noise
□
Abnormal motion
□
Oil leakage
□
Others
Description
：
□
Others
：
2
．
Service condition
Used or not
：□
YES
□
NO
Utility time
：□
24hr service
□
Interval service
Contaminate or not
：□
YES
□
NO
Product name and chemical name of the contaminant:
Types and characteristic of the contaminant:
Cleaning solvent and method of contaminant:
3
．
Content
□
Warranty
□
Paid
□
Others
4
．
Other terms
：
Assignment of applicant
Date
