Field Service Request

Part 1(to be completed by the originator of Request)

PRIORITY:

Level 1 - As soon as possible / Immediate
Level 2 - 1-3 days from work order generation to shipping completion.
Level 3 - 1 week from work order generation to shipping completion.

Customer:	Contract #:	(Example: 24700)
Attention:
Address:

Please Check Code:	NC 1	Parts Needed by Service
	NC 2	Parts Damaged by Service
	NC 3	Parts Omitted/Incorrectly Entered by Sales
	NC 4	Parts Not Released or Incorrectly Released by Engineering
	NC 5	Correct Parts Released; Incorrect Parts Supplied/Parts Missing
	NC 6	Parts Lost/Damaged in Transit
	NC 7	Warranty replacement - International
	NC 8	Non-Repairable Customer Property
	NC 9	Consignment (including show equipment)
	NC 10	Sales Discretion
	NC 11	Other

Item #	Qty	Part #	Description	Costs	DFR?
1
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Part II

Special Instructions:
Requestor:		Date:
Email:
Phone:		Fax: