LUDECA | Service Form

Incoming Repair Notice

SHIP TO: Att'n: Service Department LUDECA, INC. 1425 NW 88th Avenue Doral, FL 33172 Fax: (305) 468-1908
INCOMING REPAIR NOTICE
Required fields are noted with an asterisk (*). If info for a required field is not available, please type in N/A. We require that this form be sent to us prior to shipment. Please send this form by clicking on the 'Submit' button on the bottom on the form.
Date*
Company*		Plant*
Address*		City*
State*		Zip*

Contact1*		Phone1*
Fax1*		E-mail1*
Are you the USER for the below selected tool?: Yes No
Contact2		Phone2
Fax2		E-mail2
Are you the USER for the below selected tool?: Yes No
PO No.
Product*		Serial No.*

Customer's Problem*:

Comments:

By*:
This incoming repair notice will be kept on file for 30 days, after which time you need to submit a new one.

PRIVACY STATEMENT: Information collected herein will only be utilized by LUDECA staff and/or sales representatives to serve you better.
LUDECA, INC. will not sell or share this information with any other persons or entities.

INCOMING REPAIR NOTICE