Repair required for

• Permanent Installation Equipment
• Temporary System
• Mobile System

Equipment Supplier

• QSI
• Other supplier
• Mixed batch

Owner

• Person
• Organisation
• Business

• Owners Name

• Street / Lot:
• District:
• Parish / Province Christ Church St. Andrew St. George St. James St. John St. Joseph St. Lucy St. Michael St. Peter St. Philip St. Thomas Other
• E.C Country: Barbados Antigua & Barbuda Dominica Grenada St. Kitts & Nevis St. Lucia St. Vincent
• Postal Code

• First Name:
• Last Name:
• Office or Home Tel:
• Mobile Tel:
• Email:
• Confirm Email:

Preferred Contact Method

• Tel
• Email

I prefer to

• send or drop off the equipment at QSI's warehouse
• (Mon - Fri: 9-5, Sat: 9-2)
• have a QSI consultant visit me
• have the equipment picked up by QSI
• have the repair work done at my location
• go with an above option chosen by QSI

• Preferred date for drop off, pick up or visit
• Date and time of any functions before or after the equipment service
• What is your maximum downtime for eqipment maintenance?
• 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 hour(s) day(s)

Will you require a rental during downtime?

• Yes No

• Attach equipment list for rental...
• Attach another File
• ...or type equipment list for rental.

• Can you describe the nature of the problem?
• Date and time problem started occuring.

The system configuration

• was not alterred in any way from the normal weekly use
• was reconfigured for a special event

• What do you think caused or assisted in the failure?
• Did anything out of the ordinary happen?