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Machine Maintenance Request Form



Machine Maintenance Request Template



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:

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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:

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