Service Repair Request Form

"*" indicates required fields

Date Requested*

Company Name*

Point of Contact*

E-mail Address*

Phone Number

By checking this box, you consent to receive text messages from AllTerra Central Inc regarding your orders, inquiries, or other relevant information in accordance with our <a href="https://allterracentral.com/privacy-policy/" rel="noopener noreferrer" target="_blank">Privacy Policy</a>. You may opt out at any time by replying STOP. For assistance, text HELP. Message and data rates may apply. Messaging frequency may vary.

By checking this box, you consent to receive text messages from AllTerra Central Inc regarding your orders, inquiries, or other relevant information in accordance with our Privacy Policy. You may opt out at any time by replying STOP. For assistance, text HELP. Message and data rates may apply. Messaging frequency may vary.

Address*

How providing equipment for repair?*

Dropping Off Equipment Now

Dropping Off Equipment Later

Shipping in Equipment

Location where repair is to be done

Model # and Serial #

Requested Service - (Estimates that are not approved may incur a $75 diagnostic fee.)*

Attach file (optional)

Max. file size: 256 MB.

Turnaround Time (note: Expedited adds additional cost)*

Regular

Expedited

Promo Code

Reminder:
Click below to Submit the form. After submitting you will see a "Print Form" button. Please also include the form with your equipment.

Comments

This field is for validation purposes and should be left unchanged.