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INSTALLATION FORM
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Date / Time *
Day
Month
Year
Hour
Minutes
AM/PM
AM
PM
Company/Shop Name
*
Client's Full Name *
Prefix
Mr.
Mrs.
Ms.
Dr.
First Name
Last Name
Client's Address
Door # & Street Name
City
Postcode
Landline/Mobile Number
*
Email
*
Product Category
*
Please Select
Menu Screen
Window Display
All Three
Free standing Kiosk
No. of Products
*
Please Select
1
2
3
4
5
Product Size
*
Please Select
32
43
49
55
65
75
85
Warranty
*
Please Select
Menu Screen 1 Year
Window Screen 2 Year
Both Menu & Window Screen
Monthly Subscription
*
YES
NO
Product Installed By
*
Please Select
MR IRFAN
MR RAMANAN
MR CHANDRAN
Other
Other Installed by *
Live Status
*
Please Select
READY
PENDING
FAILED
Video Running
Product Handling Knowledge Given
*
YES
NO
Rating
*
★
★
★
★
★
Are you Satisfied with our product?
*
YES
NO
Comments
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