Customer's details
Company :		Name :
Address :		City :
Service :		Floor :
Tel :		Fax :
		E-mail :

Equipment details
	Model	Quotation
Copier :		Yes	No
Printer:		Over :

Fault details
Paper jam
Start Paper
Outgoing Paper
Document loader
Sorter
Copy quality
Code display		Mark code
Other

Modalities
You haven't got an account with ELECTRA, payment according to quotation, prior to repair
You own an account with ELECTRA
Can this form be used as a purchase order ?	Yes	No
If no, give your order number :
This order must be handed to the technician when you have your equipment serviced.