Lodge A Service Request

Conveniently book your service 24 hours a day, 7 days a week using our online booking service. You'll immediately get an acknowledgment of booking and your service will be scheduled in the earliest available slot or at a time that is convenient to you.

Firstname*
Lastname*
E-mail Address*
Site Contact Number*
Business Name*
Business Street*
Business City / Suburb*
Buisness State*
Postcode*
Phone Number
Make and Model of Product *
Please Enter The Supplier / Brand *
Serial number
Invoice number
Where did you purchase from?
Approximate Date of Purchase
Description of Problem
Preferred Date of Service
When is the service required?
Please specify preferred time (optional)
:
Additional comments

Please upload any additional information (max. 3mb)
Choose File No File Choosen
Allowed file extensions to upload: png,docx,jpg,pdf
*Disclaimer
- I agree to the Terms and Conditions laid out by DCE and it's affiliates.

Fatal error: Call to a member function toHtml() on a non-object in /home/dynamiccecom/public_html/app/design/frontend/mgstheme/sku/template/formbuilder/form.phtml on line 100