Service Request Form

Please fill out this form to request service for your lubrication equipment.

Please note that we try to look after our customer's needs as quickly as possible and providing us with as much information as possible will assist us in fixing your problem and getting your system running 100%

Please provide the following contact information:

Contact Name

Company

Street Address

Address (cont.)

City

Province

Postal Code

Phone

FAX

E-mail (optional)

Please provide the following product information on the defective system:

System is for: Motor Oil/Hydraulic Oil/Gear Oil Grease Waste Oil Other

Defective Item: Pump Hose Reel Control Valve (Gun) Remote Dispense Control
Tank Other:

Pump is mounted
Keg Drum Oval Tank (top) Skid Tank (top) Stub mount (any tank) Wall

Manufacturer: Is repair under warranty? Yes No Unknown

Purchase Date: Required for warranty repairs

Serial Number: Required for warranty repairs

Purchased From: Helliwell Equipment Other source

Description of problem:

Contact Name
Company
Street Address
Address (cont.)
City
Province
Postal Code
Phone
FAX
E-mail (optional)

System is for:	Motor Oil/Hydraulic Oil/Gear Oil Grease Waste Oil Other
Defective Item:	Pump Hose Reel Control Valve (Gun) Remote Dispense Control Tank Other:
Pump is mounted	Keg Drum Oval Tank (top) Skid Tank (top) Stub mount (any tank) Wall

Manufacturer:	Is repair under warranty? Yes No Unknown
Purchase Date:	Required for warranty repairs
Serial Number:	Required for warranty repairs

Purchased From:	Helliwell Equipment Other source
Description of problem:

Service Request Form

Copyright © 2002 [Helliwell Equipment Services Inc.]. All rights reserved. Revised: July 11, 2003

Copyright © 2002 [Helliwell Equipment Services Inc.]. All rights reserved.
Revised: July 11, 2003