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Subject *

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Full Name *

Title *

Email Address *

Phone Number *

Company Name *

Industry *

Country: *

Street Address *

City *

State/Province *

Zip/Postal Code *

How can we help you?

Documentation GA Drawing Manual Parts Diagrams

Please Provide Additional Information:

Please describe the issue:

Process Changes Changing the product makeup Increasing Unit Speed Changing the agitator design (impeller) Increasing/decreasing motor power Generating additional throughput Other

For our team to assist, please describe the type of change you are looking to make:

Mixer Information

Serial Number* ^Ⓘ

Model Number

Order Number

Size Number

Please select any files you would like to upload

I confirm the Site Address is the Service Location

Billing Address
Same as Site Address

Country *

Street Address *

City *

State/Province *

Zip/Postal Code *

Serial Number * ^Ⓘ

Model/Size

Being as detailed as possible, please describe the reason for your request.*

Is the equipment within warranty?* YesNo

If yes, when was the equipment put in service?

Requested Date for Field Service*

Requested Time Onsite for Field Service Technician*

List any site certification requirements (examples would include TWIC, Confined Space, etc.)

List all site PPE requirements (examples would include hard hat, safety shoes, FRC or Nomex, H2S Monitors, etc.)

Please list any additional site protocols that PMSL should be aware of (for example, orientation requirements, security gate protocol, policy on electronic equipment, etc.)

I acknowledge that:

The information provided above is correct to the best of my knowledge.
Unless provided with a not to exceed (NTE) estimate, costs associated with above requested field service will be billed per the Customer Field Service Rates. This includes any costs related to incorrect information or changes in schedule or scope from what is explicitly provided above.
I agree to PMSL Field Service terms and conditions.
For claims of warranty, I may be responsible for any costs incurred from the services performed in the event they are found to be outside of the terms and conditions of the factory warranty. Service costs may include travel and expenses to/from facility above, as well as labor per Customer Field Service rates, and materials (if applicable).

I am authorized to act and submit on behalf of my organization

Part information, including part description and, if known, bubble number or part number:

Part Number

Quantity

Bubble Number

PO Number (If applicable, please upload your PO below.)

Tax Exempt (If applicable, please upload your tax exemption certificate below)

Document Upload

Upload any supporting documents such as drawings, datasheets, picture of mixer name plate, purchase orders, tax exemption certificates, SDS sheets, etc. If this will be your first purchase from us, please complete our credit application and upload below.

Please select any files you would like to upload

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