Company *
Name: *
E-mail: *
Phone: *
Bill To Address: *
City *
State *	ALAKARAZCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Zip Code: *
Make and Model of Equipment needing Service: *
Do you need On-Site Service? (a Sirtage tech to come to your location?)	Yes No, I will bring the equipment in No, I can describe the problem and you can quote the repair without making a service visit.
Physical Address of Equipment needing service: *
What type of equipment is it? *	LCD/Data Projector Sound - Speakers, Mics, Amps, etc. LCD/Plasma Panels Overhead Projector Cassette Player Projection Screens Other (Please describe below)
What type of service do you need? *	Preventative Maintenance Equipment is not working. NEED REPAIRS! I have no idea. I need troubleshooting.
Approx what year was the equipment purchased? *	2008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909
Did Sirtage Sell the equipment to you? *	YesNoNo Sure
Did Sirtage Install this equipment? *	YesNoNot Sure
If you do not have the invoice number, leave this field blank.
Invoice # for Purchase of this Equipment:
First Date Available
If your first pick date is unavailable, please choose a back up date that we may use to service your equipment.
2nd Date Available
Please provide a detailed summary of your service needs:
Thank you for using our online service request form. Please note that the first date you have picked may not be available. If we can't fit you into either first or second pick date, someone will contact you shortly to find a good time to come. Once confirmed, we will contact you to let you know when a technician will be out to service your equipment. If we have any questions, we will contact you before coming. Please look out for the service confirmation email that will describe in detail the date and time we will be available to help you.
If your system or equipment is not under warranty by the Sirtage warranty, please understand there may be a minimum charge of $90.00 for this service call payable within 20 days. We will advise you before sending a technician whether or not this call will carry a charge or not.