SERVICE REQUEST FORM

COMPUTER WALL ARMS, COMPUTER CARTS AND TRACKING BOARDS

If you experience a computer mount failure and it is deemed un-usable at your facility, please adhere to the following protocol:

Report Instructions

1. Report the failure – Please provide information to help determine the nature of the problem before a technician is dispatched. You may also call us during normal business hours at 770-295-8088

2. Provide Initial Assistance - You or someone in your department may need to assist in diagnosing the problem over the phone or with photos. Photos can be texted to 770-295-8088 Please provide location and department with photos.

Select

Date

YYYY

Department

Room Number/Location

Contact Name

First Name

Last Name

Phone

(###)

###

####

Email Address

Customer Service Request/Ticket Number

Make/Model of Product:

Serial/Asset Tag Number

Needed for cart repair

Description of Problem

Any information provided about the nature of the failure will assist Cogent in solving the problem as quickly as possible.

Hours Available to Service

Urgency

Address If Not A Hospital Location

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country