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SERVICE FORM
Bank ...fA....... Date:00:92:02:2: Time:
Service Executive Name
Merchant Name :
kenpathik.
Merchant Adress...246..polbchi..nain.Road,...kAomalpe.
City ....IO. PIN Code:
Distance From Service Center (Approx. in kms)
Contact Person Name:
krhna..
Phone No.1913:48::Aa2 Phone No. 2 : .
Any other POS? Yes: No: If yes, which POS &Bank?
MID08.13A:0b:96:002.
Single TiD SR22):9:322 Multiple TiD,
(Please attach annexure and obtain merchant's initials on allpoges)
Visit Type: Installation De-Installation Replacement Training Only:
Ticket No.'
Old Device Serial No.i New Device Serial No.
Old Device Model: ! New Device Model:
Old Solution Type: Integrated Non-integrated:New Solution Type: Integrated Non-Integrated
FEEDBACK
Name :
Date0:20.9 2:3
Name
Date
BoepadhiE
OTTO248,
CLOTHING PRIVATE LIMITED: MID:O:3::3:,:S:0:9::94 0O2):
Pollachi Main Road,
Udumalpet -642126
Company seal
sgnature.&9sh234894 Company -seal
. -- -
Signature - ---