JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
MILTRONICS REPAIR ORDER REQUEST FORM
This is the repair request form for
Elevator Service Companies Only.
For all questions/concerns, please contact us at (973) 471-7700 or
hend@miltronics-inc.com
Come here often? Request a Pre-filled Link with YOUR CONTACT INFO ALREADY FILLED!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Company Name
*
(*Elevator Service Companies Only)
Please provide your company name
Your answer
Your Company Office Location
*
Please provide your company office location? (City, State) [ie. Company Name: Miltronics Location: Clifton, NJ]
Your answer
Your Name
*
Please provide your name.
Your answer
Email Address
(**OPTIONAL**)
Your Email address if available
Your answer
Your Phone Number
*
Your answer
Job Address?
*
Your answer
Will this be a drop-off, pick-up or shipment?
(Please select one)
*
I'm here now! Drop-off (Miltronics Inc. 115 Industrial East Clifton, NJ 07012)
Please send Charlie for NYC Pick-up (Call 973-471-7700 to confirm pickup)
Shipment (Please provide tracking #)
Required
(**OPTIONAL**)
Pick-Up Address?
**For Scheduled Pickups from NYC ONLY**
Your answer
(**OPTIONAL**)
Shipment Tracking #
Your answer
Type
*
Please check off category of items sent for repair
DRIVE
BOARD/PCB/Control Card
ReGen
PLC(MICROLOGIX,S7 SIMATIC,KOYO Automation Direct)
Door Operator
Encoder Replacement
Other:
Required
Mfg./OEM & Part Number
*
Please provide Brand name & Part Numbers sent for repair
i.e. Magnetek P/N HPV900-2075-2E101
*For more than one, please add quantity next to each
i.e. (1) CECF2043 / (1) CECF2042
Your answer
Describe the issue/problem with items sent for repair
(if not sure, add name + phone # for mechanic)
*
Your answer
(**OPTIONAL**)
Do you have any other requests?
Your answer
Rush, non-rush, stock?
*
RUSH
NON-RUSH
STOCK
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of Issa Lwaysi.
Report Abuse
Forms
