Tel: +44 (0) 121 459 9511 Email: info@indwash.co.uk

Service ORDER FORM

IWM will in most cases require an initial site visit to confirm requirements

IWM will contact you with confirmed order value and arrange service date on receipt of this request.

Please be aware that service visits where the machine is not made fully available despite prior arrangement are chargeable at full service rate.

Fields marked * are mandatory

Contact Details

Name *

Company *

Email *

Telephone *

Fax

Site Address *

Service Details

M/C MODEL Number *

P/O Number *

Date Requested *

To be confirmed by IWM on confirmation of order.

Scope of
Service Requested *

Important Privacy Information

IWM are fully aware of the scope of the Data Protection Act 1998 with regard to data privacy, and we are registered with the Data Protection Commission as a data contoller. We would however like to assure potential customers that any and all information supplied to IWM via this form is treated with the strictest confidence, and is not sold, passed or given to any third party for any purpose whatsoever.