Service Request Form

I am a: MerchantRetail customerInstaller

Customer / Site Address

First Name*

Last Name*

Email*

Telephone*

Street Address*

Suburb*

City*

Postcode*

Country*

Merchant Details

Merchant

Contact Name

Merchant branch/location

Phone

Installer Details

Full Name

Phone

Product Description

Product Code*

Product Description*

Waterware Packing Slip or Merchant P/O number*

Problem or issue

Attach a file

For visual defects a photo image must be supplied with this form.

To upload more than one file, add these to a zip file and attach with this form.

I agree that if the fault is not due to a manufacturing defect then any agreed costs associated with the product repair or replacement are my sole responsibility.