Breezway Service Request Form Step 1:Service QuestionsNote: A Breezway Distributor and/or Fabricator must first inspect the Breezway product to try to determine the cause of the reported issue prior to submitting this form. 1. Which month and year was the Breezway’s product supplied?2. When was the site inspection conducted? DD slash MM slash YYYY 3. What troubleshooting has been conducted?4. Which Breezway care and maintenance conditions was performed?View our care and maintenance guidelines5. Upload photos or videos to support your request: Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, mp4, mov, m4v, Max. file size: 63 MB. Step 2:Breezway’s Order Details1. Sales Order # shown on “Breezway Order Confirmation":2. Line Item # shown on “Breezway Order Confirmation”:You can find your Sales Order Number here: Step 3Product Details1. Type of Product Altair® Component Easyscreen™ System Innoscreen® System SL2® System Dualair® System 2. Affected Part: Frame Powdercoat Weatherstrip Louvre Blade Louvre Gallery Timber Reveal Handle Motor Keylock Advance Apptivate Control Unit Clip Transformer Other If Other Please Specify:3. Quantity Affected:4. Description of Issue:Step 4:Site Details 1. Type of Contact: Homeowner Builder Site Manager Fabricator Distributor Other If Other Please Specify:2. Contact Name: First Last 3. Contact Number:4. Site Address: Street Address Address Line 2 City ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 5. Is this a rural area or new area? Yes No 6. What type of site is this? (Finished Home, School etc.)7. Is there mandatory PPE? Yes No 8. Is the product easily accessible? Yes No 9. If a ladder is required, please provide approx. height from the floor to the bottom of our product:10. Is a blue/white card needed? Yes No 11. Does a site induction need to be attended? Yes No 12. Special Instructions:Note: If the Breezway service contractor finds that the reported issue is a result of product mistreatment/modification or incorrect installation etc. then all charges will be applied to purchaser/account holder referencing the associated Ticket Number (CC/TT****).Step 5:Sign Off (Customer of Breezway) By signing this agreement, you acknowledge that service charges may apply if a fault is determined to be due to improper installation of the product.1. Name: First Last 2. Company :3. Consent: I certify that all information provided is accurate and complete. By checking this box, I acknowledge this serves as my electronic signature.4. Date: DD slash MM slash YYYY All the above information must be fully completed; otherwise, the service request will not be accepted.
