Machine Maintenance Request

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Machine Maintenance Request
Name: ________________________________________________________________________
Email Address: _________________________________________________________________
Phone Number: ________________________________________________________________
Company Name: ________________________________________________________________
Department: ___________________________________________________________________
Address: ______________________________________________________________________
City: ________________________________________ State: ________ Zip: ________________
Choose the type of machine that needs maintenance:
[__] Snack [__] Soda [__] Coffee [__] Food [__] Change Machine
Please describe the location of the machine within the building:
______________________________________________________________________________
Maintenance Issue That Needs Repair:
[__] Rejecting Coins [__] Not Giving Any Change [__] Keeping Dollars
[__] Keeping Change [__] Dollar Jammed
[__] Giving Incorrect Change [__] Rejecting Dollars
[__] Selection Not Working: #______
[__] Product Not Dropping Down: #_______ or Name_______________
Other Maintenance Issues:
[__] Display Reads “Make Another Selection
[__] Frozen Soda
[__] Machine Has No Power
[__] Noisy Machine
[__] Not Cooling
[__] Light Bulb Burned Out
Comments:
______________________________________________________________________________
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