Pump Repair Application Form

Request Pick-Up

Yes

Date*

Under Warranty? (Required)*

Yes
No

Company Name*

Name

Phone

Email

Company Address*

All-Pumps Salesman

Pump Model/Brand

Description of the problem*

What is it pumping?*

DOES THE PUMP CONTAINS HAZARDOUS CHEMICALS? (REQUIRED)*

This information is crucial to ensure the safety of our pump specialists, the environment, and ensure safe handling.

Yes
No

IS A SAFETY DATA SHEET AVAILABLE (REQUIRED)*

Yes
No

Upload a copy of Safety Data Sheet (SDS)*

Drop files here or

Accepted file types: pdf, docx, jpg, png, Max. file size: 256 MB.

Comments / Special Requirements

Disposing of Pump*

I understand that All-Pumps will dispose of this pump after 3-months if no instruction is given on repair, replacement or return.

Repair Assessment Fee*

I understand that All-Pumps has the right to charge a $505 repair assessment fee to cover cleaning, disassembly, analysis and reporting. (This is waived if the repair or a replacement is proceeded with).

Name

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

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Pump Repair