DICKEY-john Corporation | Agricultural, Analytical, & Public Works Electronics

Customer Repair Form

Dear Valued Customer,

Please fill out the form below and print a copy to be sent in with the product needing service.

* - denotes required fields


 

Customer Name*
Billing E-mail*
Phone*
Fax Number

Contact Person

First Name*
Last Name*
PO #
Service Request #
Customer/OEM
Other Reference #

Billing Address

Address
City
State/Province
Zip/Postal Code
Country

Shipping Address

(if different than billing address)
Address
City
State/Province
Zip/Postal Code
Country

Additional Details

Part #
Part Description
Serial #
Date Code #
Type of work requested (check all that apply)
Repair Warranty Claims Assessment
Failure Analysis Report

Description of Problem or Symptom*

Task Performed when Problem Occurred


Technical Support and Product Service Inquires

Phone: 800-637-3302 or +1 217-438-3302
Email: djservice@dickey-john.com
Monday thru Friday 7:00am-6:00pm CST

Ship product and service request form to:

DICKEY-john National Service Center
5200 Dickey John Rd.
Auburn, IL 62615
USA