Company:
Name:
Title:
Date:
Signature:
Form filled in by:
Description of the machine:
Machine:
Model:
Purchase date:
Chassis
number:
Machine under
q
YES
q
NO
Hours of work:
warranty:
Machine working conditions
Description of defect:
Name:
Type of defect:
q
Detective mechanical component
q
Incorrect functioning
Short description of defect:
q
Electrical system failure
q
Motor failure
q
Missing component
q
Excessive noise
q
Water leakage
q
Other
Customer’s notes :
Suggestions on Pacific Floorcare’s products and / or services.
