UNIVERSAL SCHOOL OFAPPLIED TECHNOLOGY

SAGAY CITY, NEGROS OCCIDENTAL

End user
Service Department
Repair Order Form

USAT EPAS NC II LABORATORY

Date: ________________________
Owner’s Details: _____________________________________________________________
(Given Name) (Sure Name)
Address: ____________________________________________________________________
Phone: ____________________ Mobile: ___________________ Fax: _________________
Email: ______________________________________________________________________

Product Details:
Model: _____________________________ Serial Number: _________________________

Accessories Induced:

Service Cord Drain Hose Water Inlet Valve Casing

Instruction Manuals Original box other _________________

Simple Description about the Fault:

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Referrals:
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Warranty Repair (A copy of the receipt is required for warranty service)