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MILTRONICS REPAIR ORDER REQUEST FORM
This is the repair request form for
Elevator Service Companies Only.
For all questions/concerns, please contact us at (973) 471-7700 or
hend@miltronics-inc.com
Come here often? Request a Pre-filled Link with YOUR CONTACT INFO ALREADY FILLED!
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* Indicates required question
Company Name
*
(*Elevator Service Companies Only)
Please provide your company name
Your answer
Your Company Office Location
*
Please provide your company office location? (City, State) [ie. Company Name: Miltronics Location: Clifton, NJ]
Your answer
Your Name
*
Please provide your name.
Your answer
Email Address
(**OPTIONAL**)
Your Email address if available
Your answer
Your Phone Number
*
Your answer
Job Address?
*
Your answer
Will this be a drop-off, pick-up or shipment?
(Please select one)
*
I'm here now! Drop-off (Miltronics Inc. 115 Industrial East Clifton, NJ 07012)
Dropping off later! Drop-off (Miltronics Inc. 115 Industrial East Clifton, NJ 07012)
Please send Charlie for NYC Pick-up (Call 973-471-7700 to confirm pickup)
Shipment (Please provide tracking #)
Required
(**OPTIONAL**)
Pick-Up Address?
**For Scheduled Pickups from NYC ONLY**
Your answer
(**OPTIONAL**)
Shipment Tracking #
Your answer
Type
*
Please check off category of items sent for repair
DRIVE
BOARD/PCB/Control Card
ReGen
PLC(MICROLOGIX,S7 SIMATIC,KOYO Automation Direct)
Door Operator
Encoder Replacement
Other:
Required
Mfg./OEM & Part Number
*
Please provide Brand name & Part Numbers sent for repair
i.e. Magnetek P/N HPV900-2075-2E101
*For more than one, please add quantity next to each
i.e. (1) CECF2043 / (1) CECF2042
Your answer
Describe the issue/problem with items sent for repair
(if not sure, add name + phone # for mechanic)
*
Your answer
(**OPTIONAL**)
Do you have any other requests?
Your answer
Rush, non-rush, stock?
*
RUSH
NON-RUSH
STOCK
Submit
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