ASC, Inc. Service Request

ASC, Inc. Service Request
SECTION 1

Billing Information
Company Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Accounts Payable Name*

First NameLast Name
Accounts Payable Phone*

Area CodePhone Number
Accounts Payable Email Address*
SECTION 2
Contact Information (Quality Control)
Contact Name*

First NameLast Name
Contact Title*
Office Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
E-mail Address*
SECTION 3
Contact Information (at your customer's facility)
Contact Name*

First NameLast Name
Contact Title*
Office Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
SECTION 4
Component Information (non-conforming product)
Part Name*
Part Number(s)*
Quantity (+/-)*
DMN Number if available
Reject Description*
Type Service(s) Requested (select all applicable)

Visual InspectionReworkAssemblyWarehousingGuagingShipping
ASC will begin this process as soon as we receive work instruction.

Please include rejected photos and any information you will need such as lot number, serial number, work description.

Bill of lading information and all email contacts that will request this information.

PAYMENT TERMS: Payment is due within 30 days of invoice date.
If you need terms longer than 30 days, there will be a rate adjustment and the invoice will be revised.
Upload photos and other information.

Upload a File

Cancelof
Date*

MonthDayYear
Requested By*

First NameLast Name
Title*
PO Number*
Line Item Number or REQ Number
Should be Empty: