*Name

Company Name

Address Line 1

Address Line 2

Phone Number

*Email

Nature of Service Request

If Chair, what is the problem?

Arms (broken, malfunctioning)

Seat (broken, malfunctioning)

Pneumatic (height adjustment mechanism)

Casters

Other

If Other, please describe (example: torn/soiled fabric)

If not, what type of furniture is involved?

Desk

Table

Panel Systems

Light

File or Drawer

Lock or Key

Electrical Components

Please take a moment to inspect your furniture for a manufacturer's tag. Typically they are found in a bottom drawer, underneath the top cap on a panel, or underneath a work surface. To ensure prompt service, please provide as much detail as possible.

Manufacturer

Model or Serial Number

Date of Manufacture

Please describe the problem

Purchased from Scott Rice Office Works?

Yes

No

Unsure

If Yes, when did you purchase?

We will contact you to confirm receipt of your request, obtain additional information and schedule a service call.