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Machine Maintenance Request Form

Business Network Members
  1. Earthworks Professional Lawn
  2. Hibriten High School
  3. Hairmasters
  4. Pinnacle Investigations

Machine Maintenance Request Template

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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



Business Network Members
  1. Lindo's Construction
  2. Maintenance Products & Janit
  3. Measurement Devices US LLC
  4. GA Telesis, LLC

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