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Accurate Power & Technology

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SERVICE AUTHORIZATION AGREEMENT

Please fill out the form below to authorize service with Accurate Power & Technology.

Or

CLICK HERE to download the form in PDF format.

Service Requested By:
  Customer Name :
  Date of Request :
  Phone :
  Fax :
  Email :
   

Service Location Information:
Company :
Street Address :
City, State, Zip :
Phone :
Email :
Site Contact:
   

Bill To Information (if different than Service Location)
Company :
Street Address :
City, State, Zip :
Phone :
Email :
Attention:
Tax Exempt (Yes/No):
Purchase Order:
   
If Paying by Credit Card - Cardholder will be contacted for credit card info:
Cardholder's Name :
Phone :
Email for Receipt :
   

Equipment Requiring Service:
Catalog # :
Serial # :
Requested Date of Service :
Requested time of Service :
Reason for Service Request :
   
I understand that this service call is performed pursuant to Accurate Power and Technology, Inc. standard terms and conditions (attached). These will apply to this request and supersede all others now or attached to a subsequent Purchase Order. Services provided may be chargeable, if not warranty in nature or covered by a Service Agreement and therefore, agree payment will be processed according to said terms and conditions unless a separate agreement exists Accurate Power and Technology, Inc. shall be issued within thirty days of receipt of invoice.
Company :
Signed By :
   
  Enter Security Code
 

Contact Us


Give us a call at (352) 735-8285, or contact us by email, and we would be happy to answer any questions you may have.

Sales: (352) 735-8285
Fax: (352) 735-8285
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