Tri-Valley Equipment Inc
New Customer Questionnaire
Company Name:
First Name:
*
Last Name:
Phone:
*
Email:
*
Billing
Billing Address:
*
Select Address
Add an Address
Street Address:
*
Street Address 2:
City:
*
Country:
*
United States
Canada
Australia
Antigua and Barbuda
Argentina
Aruba
Bahamas
Barbados
Belize
Bolivia
Brazil
British Virgin Islands
Cayman Islands
Chile
China
Colombia
Costa Rica
Curaçao (Netherlands)
Dominica
Dominican Republic
Ecuador
Germany
Greece
Guyana
Haiti
Hong Kong
Italy
Jamaica
Mexico
New Zealand
Norway
Panama
Paraguay
Peru
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saudi Arabia
Sint Maarten
South Korea
Suriname
Trinidad and Tobago
Turks and Caicos
Uruguay
US Virgin Islands
Venezuela
West Indies
State:
*
Postal Code:
*
Address Name:
*
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New Unit Questionnaire
What type of chassis is this unit:
*
Select Unit Type
AIRPORT EQUIPMENT
BACKHOE
CHIPPER
COMPRESSOR
CRANE
CRUSHER
DOZER
DRILL RIG
END DUMPS
EXCAVATOR
FIREWOOD PROCESSOR
FORESTRY EQUIPMENT
FORKLIFT
GENERATOR ON-SITE
GENERATOR TRAILER
Light Duty
LOCOMOTIVE
MANLIFT
MATERIAL HANDLERS
MILLING MACHINE
Misc
MOWER
PAVER
PILE DRIVER
POWER UNIT
RAILROAD YARD EQUIP.
ROAD SAW
ROLLER
SCREENER
SHIP / VESSEL
STACKER
STAND ON
STUMP GRINDER
TELEHANDLER
TOOL CARRIER
Tractor
Tractor/Semi/Day Cab
Tractor/Semi/Sleeper
Trailer
TRUCK
WELDER
WHEEL LOADER
VIN
:
Year:
Make:
Model:
Unit Number:
Unit Nickname:
License Plate:
Service Request Questionnaire
Complaints / Problems / Requests
Describe first complaint, problem, or request:
*
How urgent is this:
*
Schedule As Soon As Possible
Schedule Repair Today
Emergency - Get This Fixed Right Away
Remember For The Next Visit
Add another
Scheduling & Authorization
When will the unit be available for repairs:
Now
The unit MUST be accessed at the above date and time.
When would you like the unit back:
Return ASAP
How would you like us to access the unit:
*
Select Access Method
No preference, just get it done!
Customer will bring unit to the shop
Shop will service unit on-site
Shop will pick up unit and bring to the shop
Shop will tow unit
Where will this unit be located for access:
*
Select Address
Temporary Address (please put address in the Helpful Notes below)
Add A New Address
Street Address:
*
Street Address 2:
City:
*
Country:
*
United States
Canada
Australia
Antigua and Barbuda
Argentina
Aruba
Bahamas
Barbados
Belize
Bolivia
Brazil
British Virgin Islands
Cayman Islands
Chile
China
Colombia
Costa Rica
Curaçao (Netherlands)
Dominica
Dominican Republic
Ecuador
Germany
Greece
Guyana
Haiti
Hong Kong
Italy
Jamaica
Mexico
New Zealand
Norway
Panama
Paraguay
Peru
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saudi Arabia
Sint Maarten
South Korea
Suriname
Trinidad and Tobago
Turks and Caicos
Uruguay
US Virgin Islands
Venezuela
West Indies
State:
*
Postal Code:
*
Address Name:
*
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Cancel
Would you like the shop to deliver the unit:
*
No - Customer will pick up unit from shop
Yes - Shop will return unit to customer
Where would you like this unit delivered:
*
Select Address
Temporary Address (please put address in the Helpful Notes below)
Add A New Address
Street Address:
*
Street Address 2:
City:
*
Country:
*
United States
Canada
Australia
Antigua and Barbuda
Argentina
Aruba
Bahamas
Barbados
Belize
Bolivia
Brazil
British Virgin Islands
Cayman Islands
Chile
China
Colombia
Costa Rica
Curaçao (Netherlands)
Dominica
Dominican Republic
Ecuador
Germany
Greece
Guyana
Haiti
Hong Kong
Italy
Jamaica
Mexico
New Zealand
Norway
Panama
Paraguay
Peru
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saudi Arabia
Sint Maarten
South Korea
Suriname
Trinidad and Tobago
Turks and Caicos
Uruguay
US Virgin Islands
Venezuela
West Indies
State:
*
Postal Code:
*
Address Name:
*
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Cancel
Authorization Number:
PO Number:
Notes and Instructions For Shop:
Step 4: Additional Information:
Unit Identifier:
Driver Name / #:
Engine:
Reference #:
Payment Method:
Select Payment Method
ACH
AMERICAN EXPRESS
BARTER SYSTEM
Cash
CHECK
Comchek
CREDIT MEMO
Direct Deposit
DISCOVER
E-Check
Fleet One
Internal Payment
MASTERCARD
VISA
WIRE TRANSFER
How did you hear about us (e.g. shop website):
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