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FORM PERBAIKAN MESIN

Enagic Indonesia

No.

The Plaza Office Tower


Jl.MH.Thamrin Kav 28-30
Ph ; +62-21 29923111
Jakarta 10350

Nama Pemilik

/
/
Official use Only

ID Mitra Usaha

Owner`s Name

Business ID
No.HP Pemilik
MobilePerson

Contact Person
Model

Email

Serial No

Model

Email

Serial No

Alamat Pemilik
Address Person

Garansi
Warranty

Yes
No

Aksesori yang Diterima


Accessory Received
Flexibel Yes Diverter Yes Secondary Yes
White
Yes Gray
Hose
No
No
Stand
No
Hose
No Hose
Maintenance
Request

Yes Enhancer Yes


Filter
No
Case
No

Staff Remarks
Tgl Diterima
Receive Date

Ttd Staff
Staff Signature

Comment

Maintenance
Report

Jenis pengiriman Diambil


Type of delivery Pick Up
Return Date

EMS

DHL

Lainya
Others
Ttd Penerima
Receivers Signature

No Tracking :
Tracking No :

HG
Reg

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