TECHNICAL FIELD SUPPORT FORM (SERVICE ORDER)

I. CUSTOMER INFORMATION AND ISSUE REPORTED (TO BE FILLED OUT BY CIGNAL CARE)
TICKET#:
CUSTOMER NAME:
LASTNAME FIRST NAME M.I. ACCOUNT #:
INSTALLATION
LANDMARK:
ADDRESS:
LANDLINE #: MOBILE #: EMAIL ADDRESS:
ACTIVATION DATE: WITHIN WARRANTY (Y/N)?
ERROR MESSAGE: DATE CUSTOMER REPORTED THE ISSUE:
DESCRIPTION OF ISSUE:

II. TP INFORMATION (TO BE FILLED OUT BY CIGNAL CARE)

TP NAME: High End Cellphone & Comp Shop CONTACT NUMBER/S: 09208599169
CONTACT PERSON: Mario Begino EMAIL ADDRESS: highend.cignaltv@gmail.com
TP ADDRESS: Gen. Luna St. Quinale, Tabaco City, Albay
Date of agreed field visit: Time of agreed field visit:
III. SERVICE TO BE RENDERED (TO BE ACCOMPLISHED BY THE INSTALLER AND SIGNED BY THE CUSTOMER PRIOR TO ACTUAL SERVICE CALL
DESCRIPTION (Details of service rendered, DATE RETURNED TO MSI
ITEM QTY QUOTATION ACTUAL COST (TP to fill out. For defective
nature of defect and serial numbers)
equipment for return to MSI)
n/a
SERVICES (Labor)
n/a
SET-TOP-BOX (STB)
OUTDOOR UNITS
(ODU)
SMART CARD (SC)
OTHERS (Pls. specify)

TOTAL n/a
CUSTOMER’S SIGNATURE n/a
Note: Defective STB claims should include RCA and/or HDMI cables, RCU and power supply. The Smart card should not be included if not defective.
IV. RESULT OF RECTIFICATION (TO BE FILLED OUT BY THE INSTALLER)
FINDINGS: SIGNAL READINGS AFTER RECTIFICATION OF TECH PROBLEM:
Signal Level: Signal Strength:
Signal Quality: BER:
Replacement STB/Smart Card Serial # (If STB and/or Smart Card was replaced ):
V. CUSTOMER SATISFACTION (TO BE FILLED OUT BY THE SUBSCRIBER)

1. How knowledgeable was the installer about the satellite system?
2. How courteous was the installer?
3. Was the installation time frame convenient for you (efficiency)?
5. Were you already getting programming before the installer
left? Yes or no?
6. Did the installer bring all the necessary tools and
equipment (ladder, drill, etc)? Yes or no?

4. How professional was the installer? His appearance, his demeanor?

Comments/Suggestions/Recommendations:

7. Overall, how would you rate your level of satisfaction with the installer

VI. CONFORME (TO BE FILLED OUT BY THE SUBSCRIBER)

SUBSCRIBER’S AGREEMENT
I hereby confirm that all information stated herein is true and correct.
I certify that the field visit and service work performed herein by Mediascape
Inc.’s Territory Partner (TP) was carried out in good order in the presence of
Myself and/or a member of my household.
 My Cignal kit is within warranty
I certify that defects in the concerned equipment are within
warranty and that I was not charged for the service performed
And/or defective ODU/STB/Smart Card replaced.

___________________________ _________________ ___________________________ _________________

SUBSCRIBER DATE SUBSCRIBER DATE
(Signature over printed name) (Signature over printed name)

Prepared by:
______________________________________ ____________________________
TP / INSTALLER (Signature over printed name) DATE