START-UP/TRAINING SERVICES



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Technical Service Information Form

Company Name: __________________________________________________________Date:___________________

Physical Address: __________________________________________________________________________________

City:____ _______________________________ State: ___________________ Zip: ____________________________

Contact: _______________________________ Title: _____________________________________________________

Office Phone: __________________________ Cell Phone: ________________________________________________

Fax: ________________________________ Email:____________________________________________________

Billing Address: ______________________________________________________________________________

City: ________________________________ State: __________________ Zip: ______________________________

Contact: ________________________________ Title: ____________________________________________________

Office Phone: ___________________________ Cell Phone: ______________________________________________

Fax: _________________________________ Email:_____ ____________________________________________

Thank you for the opportunity to provide start-up/training services to your company. In order to make this a beneficial trip for you we ask that you provide the following information.

• Purchase Order number (if applicable) _______________________________________________________

• Recommended hotel/motel close to your plant _________________________________________________

• Hotel/Motel Phone: _________________________ Fax: ________________________________________

• Name of the airport close to your facility _____________________________________________________

• Directions/or map from the airport to your facility _____________________________________________

_____________________________________________________________________________________

• If you are picking our technician up at the airport please advise the name of the person picking up and have that person display the placard we will fax to you for our technician to see as they exit the plane.

• Directions to your facility from the Kansas City metro area, if driving.

• Signed Labor Rate Schedule

VIC Systems International, LLC | 14560 W 99th St. Lenexa, KS 66215

Phone 913-864-0200 | Fax 913-864-05

Revised: 05/25/16

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