*First Name	Middle Initial	*Last Name
*Street Address   Street Address Line 2
*City	*State	*Zip
	NH ME MA
Company Name   *Email Address    *Verify Email
*Home Phone Work Phone Cell Phone - - -
*Service Requested
Preventative Maintenance Repair Diagnosis Parts
*Equipment Category Cardio   Strength   Other
*Type	Brand	Model #
treadmill, elliptical, weight, etc	Life Fitness, Precor, Vision, etc
Serial #
Please enter a detailed description of the problem or the work you would like completed.
*Do you believe that this product is still under warranty?
YES   NO
If 'YES' please enter:
Date of Purchase	Dealer/Store	Dealer/Store Location
*Best time to have work performed *Please note: Due to the many variables associated with scheduling and often unexpected delays regarding on-site services, we can not guarantee arrival times, however, we will do our best to accommodate your requested time and take this into consideration when scheduling.
PLEASE READ All warranty work must be performed with the owner or authorized representative present during our regularly scheduled hours of service. If under any circumstances, the warranty is no longer valid, work will be billed at customary hourly rates as presented and outlined at www.bandkfintess.com and payment will be due upon the completion of the work to be performed. Appointments required to be conducted prior to 8:30AM or after 5PM Monday through Friday will be subject to and after hours rate of $175 for the first hour (minimum rate) and $125 for each additional hour thereafter, billed in ½ hour increments. By submitting this form, you are aware of the operating and billing practices of B & K Fitness and do herby authorize work to be performed on the equipment as described above.

            By submitting this request, a work order will be generated and you will be scheduled for service.
                   You will receive a confirmation email with your scheduled date of service. If you need to speak
with a representative for any reason, please call the listed number below.