Anodyne Service Request Form
For current Anodyne wholesale customers only! Please fill this equipment service request out fully, with as much specific detail as possible.
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Email Address *
Today's Date *
MM
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DD
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Customer Account Name *
Address *
Phone Number *
Hours of Operation *
Type of Service Needed *
Who Owns Equipment *
Severity of Issue:

P1 OT: Machine cannot function or is dangerous to staff, repair ASAP. 
P1 OT is reserved for occasions where service is needed ASAP and could include overtime charges. Our aim is to have the machine fixed in less than 24 hours from when the service call was placed. 

P2: Machine cannot function or is dangerous to staff 
P2 is reserved for occasions where service is required immediately during normal business hours. Our aim is to have the machine fixed in 24 hours from when the service call was placed. 

P3: Machine is semi-functional 
P3 is reserved for occasions where service is required in a 48-hour period. Our aim is to have the machine fixed in 48 hours from when the service call was placed 

P4: Machine is functional or semi-functional
P4 is reserved for occasions where service is required with five (5) business days. Our aim is to have the machine fixed within five (5) business days from when the service call was placed. 

P5: PM Work, Installation, Filter Swap, Non-Emergency
P5 is reserved for occasions where service is not an emergency, and will be completed at the service departments availability within a reasonable amount of time.
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Equipment Manufacturer *
Equipment Model & Serial Number:
You can find this on the data plate on the front/back/side/bottom of the equipment
*
Description of issue(s): *
Any additional information:
Was the machine recently serviced? include any additional information
*
Is this service request for new equipment installation?
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