Form to obtain Extended Warranty

Equipment Model:
Serial Number:	Start-up date:
Start-up on:	Own Technician Adelco Technician Others - describe
Company:
Address:	Nº
Complement:
District:
City:
Zip Code:
Country:
CNPJ [Corporate Taxpayer’s Roll]:
Telephone:
Department equipment will be installed:
Name of department officer:
Telephone:
e-mail:
Name of person in charge of maintenance:
Telephone:
e-mail:
Register a password for future access:
Confirm password:
Was equipment received and installed to satisfaction? Enter your remarks on the field:

Help us to serve you better and provide you with the best products and services. Please, answer the questionnaire below:

Was there any problem or damage caused by transport? Yes No

Which?

Did equipment meet all technical specifications required? Yes No

Remarks:

Was the start-up operation satisfactory? Yes No

Remarks:

Is the documentation fully compliant? Yes No

Remarks:

Does your company have a specialized maintenance/operation team for such equipment? Yes No

- If no, do you wish to receive technical training? Yes No

Does your company have a specialized preventive maintenance for such equipment? Yes No

- If no, do you wish to receive technical training? Yes No

Do you have the set of spare parts for this equipment? Yes No

- If no, do you wish to purchase the basic spare parts? Yes No

Does your company have similar equipment of other brands? Yes No

Which brands?

Do you wish to receive the Extended Warranty Term? Yes No