Machine Maintenance Request
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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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