Service Request Portal – NSW

Please complete the form below with as much information as possible. Your Chemform representative will be in touch with a confirmed service date & time.

Always remember to check the Dishwasher Troubleshooting Questions or watch our Mixing Station Training Video prior to submitting the service request as it may be a quick simple fix.

Distributor Name (If Applicable)
Distributor Name (If Applicable)
Distributor Representative Name (If Applicable)
Distributor Representative Name (If Applicable)
Your Email Address*
Your Email Address
.
Customer Name*
Customer Name
Site Contact*
Site Contact
Site Contact: Number*
Site Contact: Number
Customer Email Address (Only if a confirmation email is required)
Customer Email Address (Only if a confirmation email is required)
Customer Address*
Customer Address
.
Preferred Service Time*
Opening Hours OR Preferred Service Time
Reason For Service Request*
Reason For Service Request
- Dishwasher Dispenser
- Mixing Station
- Product/Use Related
- Laundry
- Other
Description Of Problem*
Description Of Problem
Additional Comments
Additional Comments
Image Upload (If Applicable)
Image Upload (If Applicable)
Drop files here or

Max. file size: 256 MB.
Image Upload (If Applicable)
Image Upload (If Applicable)
Drop files here or

Max. file size: 256 MB.
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Service Request Portal – NSW

Service Request Portal – NSW

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