Order Form For Repairs

ORDER  FORM FOR REPAIRS


 
First Name              Last Name     
          
Company                Title                       
          
Customer Type:



   End User             Manufacturer              Reseller*              OEM*
          
Resale Number   
Bill to Street
City State  Zip 

Ship to Street   

City   State  Zip 

Phone  (  )            Fax (  ) 


Email 




*Resellers and OEMs from California contact us to supply a resale card via fax or mail to avoid paying sales tax.
Please send, deliver, or call us for pick-up if you are in the local area, so the complete pump and motor assembly can be examined by our service and repair department at Kirst Pump.

We are located at 3322 East Florence Avenue, Los Angeles, CA 90255-5834, near downtown Los Angeles. Let us know the following:

1. The nature of the problem, if known (e.g., leaky seal, burned-out motor, shaft doesn’t turn, breaker overloaded, making a noise like rocks are going through it, or a high whining noise).

2. Pump Tag Information:

Manufacturer Model Number Serial Number

Motor Tag Information:

Manufacturer Model Number Catalog Number

3. Application of unit when it failed to function properly or became inoperative.