ROBART MFG. PRODUCT REPAIR FORM

Complete this form, print and send this form along with your repair to Robart Mfg. Repair Department.
Robart Mfg. will contact you either by phone or e-mail upon completion of an estimate to authorize the repair.
Repair Labor Rate $30.00 per hour

Please include a printed copy of this form with your repair.

Cust. #:

*Name:

*Name:

Company:

Company:

*Address:

*Address:

*City:

*City:

*State/Province:

*State/Province:

*Zip/Postal Code:

*Zip/Postal Code:

*Country:

*Country:

*Daytime Phone:

Fax:

*Email:

Payment:

Credit Card no.

Part Number: (if applicable)

Action:

Call w/Estimate Repair as needed