Service Request Form


Company Information
Company Name
Name
Title
Person of Contact on Site
Physical Address
Street Address
City
State
Zip Code
Phone Number
Store ID#
Purchase Order Number
Billing Address
Same as physical address
Street Address
City
State
Zip Code
Equipment Information
Equipment Manufacturer
Equipment Model Number
Equipment Serial Number
Is unit still under manufacturer warranty?	Yes No
See warranty disclaimer below
Install/Purchase Date
Are you currently a Goodwin Tucker customer?	Yes No
Has Goodwin Tucker worked on the equipment in the last 90 days?	Yes No
If yes, what is your invoice number of the previous call?
Description of Service Needed
By filling out and submitting the service request form, your service process IS NOT COMPLETE until you have been contacted by a Goodwin Tucker service representative.
Warranty Disclaimer: Goodwin Tucker will determine if the manufacturer has approved Goodwin Tucker to perform warranty service in your area. Location will be responsible for any service charges that are considered not covered under manufacturer's warranty.