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Registered Owner’s name
Contact Person
Distributor/User ID
Contact No
Machine Model
*Email
Serial No
Address
Warranty
Yes
No
Flexible Hose
Yes
No
Divertor
Yes
No
Secondary Stand
Yes
No
White Hose
Yes
No
Gray Hose
Yes
No
Enhancer Tank
Yes
No
Filter
HG
HG-N
F8
Service Request
Receive Date
Staff Signature
*I understand that a $2.00 daily storage fee will be imposed if I do not collect the machine after 14 days from the completed job date.
*Daily storage fee will be due and payable upon pick-up of the serviced machine.
*Enagic Singapore will notify me at the phone number listed on this form when the service is completed.
*Enagic Singapore will dispose the machine if it is not collected after 6 months from the completed job date.
*Customer Initial
Date of Acknowledgment
Diagnostic Outcome:
Good To Note:
1. Please use E-Cleaner for machine cleaning every month.
2. Please make sure the calcium injection inlet switch and filter lock ring are close before use.
3. Please do not move the machine while equipped with the filled electrolysis enhancer tank.
Job Completed Date
Call Date
*I agree and acknowledge that the machine received is in good condition and the Company shall not be liable and in no way be held responsible for the machine after leaving the premises.
Date
Receiver's Signature
*This information you have provided will be kept confidential & used solely for communicating with you
Submit