Machine Repair Authorization

Please fill this out to request service for your piece of equipment.

Person who filled out MRA:
Branch Location:	- Choose - Las Vegas Reno Winnemucca Elko Round Mountain Susanville
Service Type	- Choose - Shop Field
Customer Name
Account Number
Model
Machine S/N
Preferred Method of communication	- Choose - Email Cell Office Phone Fax
Name
PSSR Comments:
PSSR Name:	- Choose - Bill Black Joe Costa Tom Huff Jami Heiskenan Steve Callahan Tom Limov Jake Spencer Gale Griggs Steve Rush Richard Hall Gary Slagle Dave Bequette John Cherne Don Palmquist Mike Guillen Eon Roberts Loyce Seastrunk Wesley Pete John Richards Chris Lantz Jason Williams Eric Breer
PSSR Notified?	- Choose - Yes No
Purchase Order Number:
Reason for repair
Save Parts?	- Choose - No Yes
SMU
Transferred From
Warranty Consideration?	- Choose - No Yes
Special Instructions/Customer Comments:
Arranged By
Contact Frequency	- Choose - Daily Every Other Day Weekly Change in status
Customer Cell Number:
Customer Contact Name:
Customer Email:
Fax Number:
Customer Phone Number:
Date Needed By
Date Received
Date Shipped:
Disassemble and Quote?	- Choose - Yes No
Equipment #
Was Repair Estimated?	- Choose - Yes No
Inbound Transport Information
Method of outbound transport:
Work Order Number:
Customer Signature

Please enter the code shown above: