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Warranty/Service Call Request Form
Please fill out this form and fax it to Higgins Agencies on (08) 9467 7505

Note: If the result of this call is NOT covered by the manufacturers warranty then the customer will receive a $35 call out fee plus $65 per hour, payable to the service agent before leaving.
Customer Details
* Name
* Address
* Company
 
* Phone
* City/Suburb
Fax
State/Region
Email
Post Code

Location Of Unit
* Contact Name
* Address
* Contact Phone
 

Product Details
Purchase Date (dd/mm/yyyy)
* Install Date (dd/mm/yyyy)
* Product Description

* Manufacturer
* Product Serial #
*Fault
(as per customer)

Please enter the code as it is shown:
* Submitting this form indicates you have read, understood, and accepted our warranty returns Terms & Conditions and agree to pay the account if the fault is not covered by the manufacturers warranty.