* = Required Field Department Name * Customer Name * Note: Person authorized within the department to make financial decisions. Phone Number * Note: Person authorized within the department to make financial decisions. Email Address* Note: Person authorized within the department to make financial decisions. Purchase Order Number * Note: Parts request without a purchase order number will not be processed. Invoice PreferenceMailedEmailed Mileage* Engine Hours* Pump Hours Aerial Hours Authorized Department Customer Representative* Note: This person is authorized and responsible for financial decisions Authorized Customer Contact Email* Authorized Customer Contact Phone Number* Drop Dead Completion Date Budgetary Limit Complaint(s)* Terms & Conditions* 1. It is the responsibility of the “Customer” to remove all City or Department owned loose equipment from apparatus (including but not limited to radios and hose) prior to delivery to repair facility. Golden State Emergency Vehicle Service, Inc. shall not be responsible for theft or damage to equipment. 2. Fuel is the responsibility of the “Customer” to transport apparatus. 3. It is the responsibility of the “Customer” to transport apparatus to and from repair facility unless otherwise mutually agreed upon by Golden State Emergency Vehicle Service, Inc. If Golden State Emergency Vehicle Service, Inc. has been contracted to transport vehicle upon “Customer” behalf the apparatus must be in safe operating condition. If GSEVS is transporting the apparatus GSEVS is not responsible for broken or chipped windshields, paint chips or drive train failures due to lack of maintenance. 4. It is the responsibility of the “Customer” to leave keys with Golden State Emergency Vehicle Service, Inc. if the apparatus has locking doors on the cab and or body. 5. In regard to air system “pressure leak” concerns, GSEVS does not make any warranty with respect to corrective repairs for air leaks whether expressed or implied. Please acknowledge that you agree to the above terms and conditions: File Attachments Send me a copy of my responses
