Hurst Repair Form

The following parts, labor and adjustments will be replaced, repaired or performed as needed and are covered by this agreement:

Check tightening

New Hydraulic Fluid

Pump Pressure adjustments

Spark plug (Changed)

Air Filter Cleaned

Carburetor adjustments

Clean, Lube, Decals

Muffler Screen (cleaned if necessary)

Available parts in stock for purchase upon request:

Engine or Motor assembly	Pump assembly	Auto Tips & Retaining pin	Reservoir Plug & Breather	Tool Housing	Cutter Blades
Roll Cage and Attached Parts	Automotive Parts	Hose Couplings (Quick)	Grab hooks Reservoir	Chain and Shackles Reservoir	Auto Tips & Retaining Pin
Hoses	Muffler	Tool Arms	Control Valves	Tool Housing	Gas tank

Please fill out the form below.

Full Name: (required)

Email Address: (required)

Phone Number: (required)

Your Company / Department: (required)

Address:

Unit Number:

This agreement authorizes Newton's Fire and Safety (Authorized sales and service distributor for the Hurst Jaws of Life Products) to perform during one Annual Service call, preventative maintenance and tune up on the Hurst Rescue System listed below (only one power unit per contract).

Power Unit:

Serial Number:

Tool 1:

Serial Number:

Tool 2:

Serial Number:

Tool 3:

Serial Number:

Tool 4:

Serial Number:

Tool 5:

Serial Number:

Additional power units will be each $350. Each Additional Tool $25 (More than 5) (List additional units on separate Form) Cost of this agreement is $650.00 per annual service with an option to renew annually. The date of this agreement will be the date the service will be the date this service agreement is received by Newton's Fire & Safety. No additional travel fee will be charged for this service agreement. A loaner tool or pump will be provided if we have to bring yours in for service.