Customer Information Form

Enter your information on the form below:
(* indicates a required field)

STEP 1: Customer Information
Customer First Name	*
Customer Last Name	*
Customer Address	*
City	*
State	*
Zip	*
Primary Phone #	*
Secondary Phone #
Customer Email Address	*
Verify Email Address	*

STEP 2: Service Plan and Warranty Info
Was the unit purchase in the last 2 years?	Yes No
Was an extended service plan purchased?	Yes No
Extended service plan #

STEP 3: What is wrong with the unit?
Describe the initial problem:*
Initial Assessment of Problem
Does the unit start?	Yes No	Was this unit used in a commercial setting?	Yes No
Does the unit sputter or stop?	Yes No	Are the accessories present with the unit?	Yes No
Does the unit smoke, at  start up or all the time?	Yes No	Is the unit free from obvious damage?	Yes No
Does the engine die out after running for a period of time	Yes No	Unit condition?	Good Poor
Was the oil, spark plug, and air filter changed within the last 12 months	Yes No