Form filled in by:
Firm:
Name of compiler:
Position in the firm:
Date:
Signature:
Description of the machine:
Machine:
Model:
Purchase date:
Chassis
number:
Machine under
warranty:
YES
NO
Hours of work :
Point out working
environment of the
machine:
Description of defect:
Code of detective
particular:
Name:
Typology of defect:
Short description of defect:
Detective mechanical component
Incorrect functioning
Electrical system failure
Engine failure
Missing component
Excessive noiseness
Water leakage
Other
Customer’s notes :
Please point out notes and/or suggestions on products / services of Ing. O. Fiorentini S.p.A.
