HIE Service Quote

• Date

  Date

• Diagnosed on Call No.

• Technician

• Is the Unit Down?

  Yes

  No

• Customer

• Contact

• Contact Phone / E-Mail

Equipment Information

• Equipment No.

• Make / Model

• Serial No

• Hours

Quote

• Description: Please explain Cause and Correction:

• Is this a Required or Recommended Repair?

  Required

  Recommended

• Diagnose Hours

• Est. Hours to Complete Repair

• Parts Required

  Yes

  No
Part

• Part Number

• Part Description

• Quantity

• Picture

  Media