Thompson & Johnson - Service Request Form

SERVICE ORDER FORM
* = Required Field
COMPANY INFORMATION
*Company Name:
*Address:
*City, State, Zip Code:
Attention:

SHIP TO: (If different)
Company Name:
Address:
City State, Zip Code:
Attention:

CONTACT INFORMATION
*Contact:
*Email:
*Phone:	Fax:

EQUIPMENT INFORMATION
*Make:	*Model:
*Serial #:

RENTAL EQUIPMENT
Is Rental Needed? Yes No
If Yes:
Specifications:
Fuel:LP Gas Diesel Electric — Voltage:
Lifting Height:	Lowered Height:
Fork Length:	Tires: Cushion Pnuematic

REPAIR INFORMATION
Repairs to be done at? On-Site T&J Facilities
Wanted Date:
Estimate Needed? Yes No
Type of repair needed. PM (Planned Maintenance) Tune-Up Winterize Breakdown Repair No Start Leaking — Color of Fluid: Other:
Detail of Problem/Repairs Needed:
Special Instructions:
Amount Approved:
P.O. Number: