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Section 1.
Company:
Return Address:
Contact:
Contact Email:
Phone No:
Cust Ref:
Fax No:
PRODUCT DETAILS
Section 2.
Manufacturer
P/O No:
Serial #
Model #
Asset #
Accessories
Returned
Description of Fault
Wrty Type
Charge Type
CUST SW
RELOAD
MFR WRTY
MFR CNRT
LEOP CNRT
CHARGE GOAHEAD
QUOTE
YES
NO
MFR WRTY
MFR CNRT
LEOP CNRT
CHARGE GOAHEAD
QUOTE
YES
NO
MFR WRTY
MFR CNRT
LEOP CNRT
CHARGE GOAHEAD
QUOTE
YES
NO
MFR WRTY
MFR CNRT
LEOP CNRT
CHARGE GOAHEAD
QUOTE
YES
NO
MFR WRTY
MFR CNRT
LEOP CNRT
CHARGE GOAHEAD
QUOTE
YES
NO
MFR WRTY
MFR CNRT
LEOP CNRT
CHARGE GOAHEAD
QUOTE
YES
NO
MFR WRTY
MFR CNRT
LEOP CNRT
CHARGE GOAHEAD
QUOTE
YES
NO
Section 3.
This form should only be used by current customer Account holders who wish to send a device to Leopard Systems for examination and/or repair. To qualify as an Account customer, you must maintain a minimum serice spend of $1,000 per
month and have satisfied the Company's credit pproval process. Please note there is a minimum $80 + GST examination charge per device sent to Leopard Systems for examination or repair quoting. This fee is absorbed as part of the total
charge where the customer accepts and authorises the go ahead to proceed with the repair. No work will commence on a device unless all information is provided on this form. All quotes will be sent via email therefore please ensure a
contact email is included.
This form is to be completed by the customer in its entirety, printed and returned with the accompanying devices to:
Leopard Systems Repair Centre: Suite 1, 322 St Kilda Rd, St Kilda VIC 3182
www.leopardsystems.com.au
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