DEFECT AND ASSEMBLY FORM Box 760, 275 Hespler Ave, Winkler, Manitoba R6W 4A8 T: (800) 418-9461 P: (204) 325-4195 F: (204) 325-8116 www.convey-all.com conveyors@convey-all.comName (Dealer or Assembly Person)(Required) Business Name(Required) Phone(Required) Email(Required) Brand(Required)Convey-AllModel Number (eg. 1658TL, CST1500)(Required) Serial Number(Required) Date of Defect(Required) MM slash DD slash YYYY Photo of DefectParts missing or damaged (if any)Estimated/Actual Fix Summary(Required)CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
