Company Name

Name of Requester

Title or Postion

Model Number

Serial Number

Machine Location in Store

Email Address

Parts Order Request (Part Number and/or Description of Part)

Service Call Changes
149 Miles or Less ($100.00 from Sacramento150-199 Miles ($150.00 from Sacramento)

Additional Services Offered
Preventative Maintenance (Pricing depends on machine)Training ($295.00)Deep Cleaning (Pricing depends on location)

Is your equipment under warranty? (Machine 1 year old or newer)
YesNo

*Money Saving Tips - Having the machine emptied out before the technician arrives could save up to one hour of labor. Product completely thawed or premixed can eliminate unnecessary labor.

Description of Machine Failure

Discount Code

How did you hear about us?
---FacebookTwitterMail/FlyerWord of MouthGoogleOther

By typing your name on the line listed below, you consent to all charges related to diagnosing, authorized servicing, maintaining, or training. All charges based upon non-emergency rates. Weekend and late night urgent requests are extra. Travel charges and a half hour minimum are applied upon technicians arrival. Each trip provided will be accompanied with a travel charge. Intermittent mechanical issues not occurring while technician is present will still result in labor and travel charges. Each trip will be invoiced separately even if problem(s) still exist. Arrival times by technicians are subject to change. Time blocks for arrival will be given by Electro Freeze of Nor Cal. Customer must be present during time blocks given or wait time for technician will be applied . All non-wearing parts installed by Electro Freeze technicians are covered up to one year. Labor and craftmanship done on SPECIFIC work, is covered up to 90 days as long as customer approves all work proposed at time of diagnosis. We DO NOT service or ship outside of our territory.

Sign Name Here (full name)