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Machine Maintenance Request Form







Business Network Members
  1. Lapierre Heat & Cool
  2. Blues Cafe
  3. Clancy Dignam
  4. Touch Of Glass






Machine Maintenance Request Template

Word   PDF  


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:

_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________








Business Network Members
  1. Race Drilling, Inc.
  2. Brook Park Chamber of Commer
  3. Variview
  4. Reflexx Robotics






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