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Service Requested:
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Maintenance
Repair
Name
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Mrs
Mr
Ms
Dr
Phone
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Email
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Address
Number of Floors:
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2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
20+
Type of Units:
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Hydraulic
Geared
Gearless
Escalator
Others
Model (if known)
Present contract termination date: (if applicable)
Number of Elevators:
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1
2
3
4
5
6
7
8
9
10
10+
Controller Manufacturer:
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Otis
Kone
Schindler
Thyssen
MCE
Dover
Not Sure
Other
Type of Facility:
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Office
Apartment
Hotel
Hospital
Retailer
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Additional Notes: (optional)
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