Service Request Form

DATE ___ /___ / ___

SERVICE REQUEST FORM

Please read and sign important note at bottom of page

and fax form back to 08 8353 4042 or email to .au

Supplier/Store:

Branch:

Name of person

completing this form:

Original order No:

Date of purchase:

Product name

Product model:

Nature of Problem:

Customer name:

Address where

product is installed:

Customer

Phone number:

Was item installed by

YES

a licensed plumber?

IMPORTANT NOTE:

Should the item of this request for service, be proven to not be a Elwa Pty Ltd supplied product,

or it is proven to be an installation fault, a call-out fee and labour costs shall be charged to the

person making this request.

I agree & accept the above terms (Signature)

(Full Name in Print)

233 Richmond Road

T 08 8353 4040

GPO Box 776

Richmond SA 5033

F 08 8353 4042

Adelaide SA 5001

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Parent category: Business