Warranty Registration

Full Name*

Title First NameLast Name

Landline Number *

Area CodePhone Number

Mobile

E-mail*

Equipment Serial Number*

This can be found on the equipment

Other Serial Numbers

Where is the equipment located?*

As above

Seperate organisation

Organisation name

Contact Name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Are you authorised to instruct Astor Bannerman to carry out charegeable works?

YesNo

Is a Purchase Order number required ?

YesNo

If the cost of parts are under £50.00 +VAT

Authorised to proceedPlease provide a Quotation

If the cost of parts are over £50.00 + VAT

Authorised to ProceedPlease provide a Quotation

To proceed with repairs is a Purchase Order required?

YesNoIf parts are over £50.00 + VAT

Please send quotes to:

Astor Bannerman will not pass your information on to any third party unless required to do so by law or it is essential for the implementation of a service contract or warranty callout. Astor Bannerman will always try to contact you in the unlikely event that a safety issue is identified with your equipment.

Thank you for taking the time to update our service contracts contact details. Would you be intrested in completing a short Customer Satisfaction survey? Your feedback would be greatly appreciated

YesNo

How satisfied are you with the standard of service you received from Astor Bannerman Medical Ltd.

	1	2	3	4	5

1 is Totally dissatisfied, 5 is Very satisfied

How responsive were Astor Bannerman Medical staff to your enquiries?

	1	2	3	4	5

1 is Unresponsive, 5 is Very responsive

How polite and helpful were Astor Bannerman Medical Ltd's engineers?

	1	2	3	4	5

1 is Not polite or helpful at all, 5 is Very polite and helpful

What changes can you suggest for Astor Bannerman Medical Ltd to improve its customer service?

Service Contract

About You

The Equipment

Repair Authorisation