ARTT Dealer Service Request Form

ARTT Dealer Service Request Form

Date Service Requested*

Servicer Type*

Select or enter value

Servicer Name*

If you are a self-service dealer you do not have to provide dealer information below.

Select or enter value

Servicer Street Address*

Servicer City*

Please enter company name, address, phone, email and contact name.

Servicer State*

Select or enter value

Servicer Zip*

Servicer Phone1

Phone

Service Company Email*

Service Company Contact*

Distributor Product Purchased From*

Select or enter value

Location of Unit*

If service is required in customer home complete all info below

Select

Model Number*

Select

Serial Number*

Service Issue*

If Drop Down Does Not Have The Choice You Need Use The Box Below!

Select or enter value

Explain Issue with Product

Date of Purchase*

Proof of Purchase File Upload*

Copy of purchase receipt or invoice must be attached to receive authorization.

Drag and drop files here or

Dealer Name

Dealer Street Address

Dealer City1

Dealer State1

Select or enter value

Dealer Zip

Dealer Email

Dealer Phone

Dealer Contact Name

Customer Full Name

PLEASE COMPLETE THIS SECTION IF THE UNIT IS IN THE CUSTOMERS HOME

Customer Complete Address

Customer Phone

Phone

Customer Email Address

Send me a copy of my responses

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