At-Customer-Location Equipment Repair Request Form

"We'll Come to You and Fix It"

Contact Information: for reaching you regarding this request

Primary Contact Name:
Primary Contact Phone:
Best time to contact you:
Email Address:
Alternate Contact Name:
Alternate Contact Phone:

Equipment and Issue Description: Please provide as much information as possible to explain the issue. The more we can focus on fixing your gear versus figuring out what is wrong with it, the lower the service charges.

Equipment description:
Equipment models and serial numbers, if available:
Are you seeking repair under manufacturer's warranty?
 No (bill me) 
 Yes (Please call first for authorization: 800-622-7850) 
Is this an inspection/maintenance request or a repair request?
 Not sure 
Are you interested in discussing a maintenance agreement for the site that would provided you added financial benefits?
 Yes. Please call me to discuss before proceeding with this request.. 
 No thank you 
If this is for inspection/maintenance - as opposed to repair(s), what details can you provide us?
If the issue is electrical failure or danger, check all that apply:
 Was dropped 
 Had fluid spilled on it 
 Just stopped working 
 Made a bad noise 
 Gave someone a shock 
 Created sparks 
 Emitted a strange smell 
 Blowing fuses or tripping circuits 
 Some channels/functions not working 
 Switches/knobs/outlets(outputs)/inputs not working 
 Works but overheats 
 Works for a while, then stops 
Further explain your selection(s) below.
Further explanation of electrical problem:
If the issue is mechanical failure or danger, please check all that apply:
 Internal mechanism not working 
 Hinge(s) broken 
 Handle(s) broken 
 Foot/feet broken 
Further explanation of mechanical problem.
It it needs modification(s), check all items that apply:
 Increase capacity 
 Decrease capacity 
 Add switches 
 Add knobs 
 Add outlets/outputs 
 Add inputs 
Further explain your selection(s) below.
Further explanation of modification(s) needed:
Are there any other issues? (if yes, please explain)
Want rush service? (our current lead time for on-site repair is approximately 2-4 weeks)
 Yes, please rush. I understand a $100 rush fee will be added to whatever inspection, maintenance or repair charges apply, unless there is a pre-existing maintenance/repair agreement in place for the site. 

Payment Information:

Payment Method:
 On Account (provide PO # below) 
 Credit Card (call me for cc details; I understand that work cannot commence without payment information on file)) 
You will be invoiced - referencing your PO - or your credit card will be charged upon completion of the service/repair.
PO Number:

By submitting this form, you are indicating acceptance of all provisions incorporated into the above and the following Terms and Conditions:

Equipment Service and Repair - Terms and Conditions

Factory & Manufacturers Warranties

Customer understands that PNTA Service Technicians are trained by a number of International manufacturers to install, commission, operate, diagnose and repair equipment in our area of expertise. However, Customer retains full responsibility to notify PNTA if equipment is under warranty and provide proof of purchase (required by Manufacturer) as technicians who perform services without manufacturer authorization on said equipment can render any warranty void.

Fees & Charges:

PNTA reserves the right to charge for its labor at various rates according to the complexity of the project and source of the equipment repair. Equipment purchased through PNTA, as evidenced by your receipt, may qualify for reduced hourly labor charges.


A PNTA Service Technician will examine equipment submitted for repair and, if requested, will provide a written estimate or "range" of labor and replacement parts costs prior to proceeding with repair. Details of estimates will be communicated by email and your reply by return email or fax will be deemed as acceptance of both the estimate and these terms and conditions. Once you have accepted the estimated cost of repair, you will be notified if unforeseen complications warrant additional costs.

In the event you decide NOT to proceed with an estimated repair, you will be charged for the Service Technician's time up to that point plus a) if you want the equipment returned, you will be charged for repackaging for shipment and shipping charges, or b) if you abandon the equipment or direct us to dispose of it, you will be charged the actual disposal fee incurred by PNTA. Any equipment is deemed "abandoned" if it is not picked up within 30 days.

Payment & Collection of Repaired Equipment:

PNTA will invoice you upon completion of the repair. If you do not have a PNTA Credit Account, your credit card will be charged for the cost of repairs. A PNTA representative will contact you to notify you that your equipment is ready for pick-up, at which point you may elect to have the equipment shipped to you at your cost. Any equipment that is not collected within 14 days will be shipped to your billing address at your risk and expense. In the event where we have no address for you and we have made unsuccessful attempts to contact you, we will, after 1 calendar month of completion of the repair, consider the equipment abandoned and dispose of it at our discretion.

The Work:

PNTA will repair or replace defective or failed parts with new parts or components when available. Refurbished parts or custom-built parts may be used when the equipment is no longer manufactured or new parts are unavailable. If such repair or parts replacement is needed because of equipment malfunction or failure, PNTA will not extend its service to additionally alter the appearance, cosmetic, decorative or structural aspects, including framing unless you specifically request such service.In time, all equipment reaches a point when it is no longer economical to repair, or may be considered too dangerous to operate under normal conditions; wherever practical, we will notify you of our findings and generally recommend appropriate disposal. It is our policy to remove the electrical plug on any unsafe equipment.


PNTA Service Technicians guarantee their workmanship for 30 days after completion of the repair. PNTA specifically disclaims all warranties, express or implied, including - without limitation - the warranties of merchantability or fitness for a particular purpose. In no event will PNTA be liable for any special, indirect, incidental, or consequential damages even if we have advised of the possibility of such damages.

The Customer shall bear the cost of all shipping charges related to repair or service equipment, although we will attempt to minimize said shipping costs.


Only while on PNTA property is your unrepaired equipment insured against loss by PNTA. The equipment returns to your responsibility upon pickup or shipment from our facility.


Customer agrees to pay for PNTA Technical Services at the time the repair or service is completed. PNTA offers Account terms (Net 30) on pre-approval of credit and we will happily charge to your account, subject to your authorization and provided the account is in good standing.