|
|
Check One
*
:
|
|
If Safety/Service Publication Provide ID:
|
Safety/Service Publication:
|
|
|
Contact:
|
Company Name:
|
|
Email Address
*
:
|
|
Contact First Name
*
:
|
|
Phone Number
*
:
|
|
Contact Last Name
*
:
|
|
|
Address:
|
Address Line 1
*
:
|
|
Country
*
:
|
|
Address Line 2:
|
|
City
*
:
|
|
Address Line 3:
|
|
State/Providence
*
:
|
|
|
Postal Code:
|
|
|
Contact:
|
Company Name:
|
|
Email Address
*
:
|
|
Contact First Name
*
:
|
|
Phone Number
*
:
|
|
Contact Last Name
*
:
|
|
|
Address:
|
Address Line 1
*
:
|
|
Country
*
:
|
|
Address Line 2:
|
|
City
*
:
|
|
Address Line 3:
|
|
State/Providence
*
:
|
|
|
Postal Code:
|
|
Select (1) Component and Enter Serial Number
*
:
|
|
Serial Number:
|
|
|
Provide Details about the Cause for Replacement or Repair:
|
Cause for Replacement or Repair
*
:
|
Date of Failure
*
:
|
|
|
Reference Number:
|
|
Please refer to your LiftPod Operation, Safety, Service and Maintenance Manual or Safety/Service Campaign Publication for replacement kits. See Section 6, Service and Maintenance.
|
Enter Quantity of Part and Part Number needed for Repair:
|
|
|
I CONSENT TO JLG COLLECTING AND PROCESSING MY DETAILS IN ACCORDANCE WITH ITS PRIVACY POLICY.
|
|
|
This form collects your name, contact number and email address so that our teams can communicate with you and respond to your query. Please read our Privacy Policy to see how we protect and use your submitted data.
|
|