Conair Request for Service

Conair - Reliable Solutions for Plastics Processors

Please Complete all of the Information Needed Below to Process a Service Request for a Technicians visit
(Required Fields are in red)

Company Name:

Street Address:

City:

State:

Postal Code:

Date of Request:

Requested Date of Service:

Contact Name:
(first and last)

Title:

Phone Number:

Fax Number:

Email:

Equipment Model Number:

Serial Number:

Payment Method: (you must choose one of the three options below)

Paid Service

Under Warranty

Other

Purchase order number:

Needs to be verified by Conair.

Describe service:

The field above is required ONLY IF you choose the Other option.

Requested By:

Title:

Problem:
(Explain in detail)