Site Visit and Commissioning Request Form
YOUR OFFICIAL PURCHASE ORDER MUST ACCOMPANY THIS SITE REQUEST AND ALL SECTIONS MUST BE COMPLETED AS A REQUIREMENT FOR OUR HEALTH & SAFETY POLICY. Please ensure that Purchase Orders are addressed to Grundfos Pumps Ltd.
Agent/Distributor
*
Note: Company with Direct Grundfos trading account
Address
*
Street Address
Street Address Line 2
City
County
Postal Code
Contact Name:
*
Landline Telephone Number:
*
Mobile Telephone Number:
*
Email
*
This email address will be used to confirm receipt.
Site Name
*
Site Address
*
Street Address
Street Address Line 2
City
County
Postal Code
Site Contact
*
Site Mobile Phone Number:
*
Site Landline Phone Number:
*
Site Email Address
*
example@example.com
Grundfos Sales Manager's name
First Name
Last Name
Grundfos Sales Manager's Email Address
example@example.com
Is induction required?
*
Yes
No
Time of Induction
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Length of Induction
*
In hours, e.g. 0.5, 1, 2 etc.
Work Type
*
Warranty/repair
Chargeable/repair
Commissioning
Description of work required
*
Please include here any other relevant info, e.g. if inductions are required on a specific date.
Order Number:
*
Required for all works to be carried out
Configurable list
*
Is any work to be carried out in a confined space?
*
Yes
No
Is ladder access required?
*
Yes
No
Unsure
Is the pump easily accessible?
*
Yes
No
Unsure
You have selected "yes". Please tick here to accept that if, upon arrival, the engineer cannot easily access the product, that you will be liable for the full cost of the visit.
I accept liability if the product is not accessible.
Please upload your Purchase order and any relevant documentation here:
*
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