Mobilization Request Form Urgent/Emergency Services

Urgent Srvice Request for Australia & New Zealand

Emerson employs skilled and experienced Field Service Technicians/Engineers that can be deployed to your site locations to perform diagnosis, trouble-shooting and rectification work on your equipment. We understand that in some instances, such Services are required to be secured in short timeframes, to respond to urgent situations.

Many of our customers have long-term Service Agreements in place which allow Field Service Technicians/Engineers to be deployed at short notice to perform urgent Services. Should your organisation have such an Agreement in place please contact us to discuss arrangements for the Services you require. Should your organisation not have such an Agreement in place, the ‘Urgent Service Request Form’ provides a mechanism to enable you request the rapid deployment of a Field Service Technician/Engineer to your site to meet your urgent requirement.

This urgent service is dependent on:

Our confirmation of availability of the required personnel
Your agreement to credit card payment of the $1000 (GST-exclusive) Call-out Fee, any additional fees for Services performed in excess of the Call-out allocation, and any associated travel costs for personnel (where applicable)
Your agreement to the Emerson Process Management Terms and Conditions of Sale of Goods and Services.

Please complete all sections of the Form, and ensure that you click on the ‘Submit’ button in order to lodge your request for action. Once received, we will endeavour to contact you within 24 hours to provide confirmation of your request.

YOUR DETAILS

Company*

ABN*

First Name*

Last Name*

Business Email Address*

Country*

Business Phone*

Mobile Phone

Date

Industry*

Job Responsibility*

SERVICES REQUIRED

Please describe the product and/or application and provide a brief description of the issue:*

Special requirements / Safety Inductions, etc:

TRAVEL ARRANGEMENTS

THERE MAY BE A NEED TO DEPLOY FIELD PERSONNEL FROM INTERSTATE OR OUTSIDE OF YOUR LOCAL AREA, DEPENDING ON THE NATURE OF THE SERVICES YOU REQUIRE, THE TIMEFRAMES WITHIN WHICH THOSE SERVICES ARE REQUIRED, AND AVAILABILITY OF PERSONNEL.

YOU MAY ELECT TO BOOK AND PAY FOR THE REQUIRED TRAVEL YOURSELF, PROVIDING US WITH THE RELEVANT INFORMATION (E.G. ITINERARY, RESERVATION NOS. ETC) OR WE CAN BOOK IT FOR YOU ON A COST PLUS 15% BASIS. SHOULD PERSONNEL TRAVEL BE REQUIRED, PLEASE INDICATE YOUR PREFERENCE FOR COVERING THE COST OF SUCH TRAVEL BY SELECTING AN OPTION BELOW:

Travel Arrangements

My organisation will book and pay for any travel required by the nominated Field Service Technician/

My organisation requests that you book the travel required by the nominated Field Service Technician

ANY TRAVEL REQUIREMENT FOR PERSONNEL WILL BE DISCUSSED AND CONFIRMED WITH YOU BEFORE THE SERVICES ARE BOOKED.

PAYMENT DETAILS

PLEASE PROVIDE CONTACT DETAILS OF YOUR NOMINATED CREDIT CARD HOLDER OR ACCOUNTS PAYABLE DEPARTMENT SO WE CAN CONTACT THEM TO ORGANISE CREDIT CARD PAYMENT (VISA, MASTERCARD OR AMEX) OVER THE PHONE.

PLEASE NOTE THAT IN ACCORDANCE WITH THE PAYMENT CARD INDUSTRY DATA SECURITY STANDARD (PCI DDS), YOUR CREDIT CARD DETAILS WILL BE USED FOR A SINGLE AUTHORISED TRANSACTION AND WILL NOT BE STORED ON OUR SYSTEMS OR TRANSMITTED TO ANY OTHER PERSON.

Contact Name*

Contact Number*

Email Address*

TERMS AND CONDITIONS

By clicking I ACCEPT, you:

• Confirm you are authorised to request this service on behalf of your organisation.

• Acknowledge your acceptance of the Emerson Process Management Australia Pty Ltd Terms and Conditions of Sale of Goods and Services, a copy of which can be accessed via this link for Australia and this link for New Zealand.

• Recognise that submission of this Form is not a guarantee that we will provide the Services you require. However, we will endeavour to contact you within 24 hours to confirm our ability to provide the requested Services and the details of those Services

(e.g. date/time/name of Field Service Technician/Engineer to be deployed) and to seek your written agreement to any additional travel expenses for personnel, where applicable.

• Agree that once we have confirmed details of the Services with you, we will contact your nominated Credit Card Holder or Accounts Payable Department to organise payment of the Call-out Fee and any out-of-pocket travel expenses for personnel (where confirmed in writing by you). Payment is required to be made by Credit Card, unless otherwise agreed with you. Once the Services have been

confirmed and payment made, the Call-out Fee and travel expenses (where applicable) will not be refunded in the event that you cancel the requested Services.

• Understand that the Call-out Fee will entitle you to a maximum of 4 hours of on-site Services by the Field Service Technician/Engineer deployed to your site. However, we cannot guarantee that the Services you require will be able to

be completed within the designated 4-hour timeframe due to a range of factors including actual site conditions, delays, or scope complexity encountered. Additionally, any stock/spare parts utilised by our Field Service Technician/Engineer are additional to the Call-out Fee and will be charged to you at cost.

• Agree that if the required scope is not be able to be completed in 4 hours (or you require additional Services) you will be charged for actual time spent in completing the scope and/or performing the additional Services at a rate of $250 per hour for each hour or

part thereof over the initial 4-hour allocation, as documented in the Field Engineer’s Report that we will submit to you. This additional sum, together with the cost of any stock/spare parts used, will be payable by Credit Card, in accordance with the Payment Details provided by you.

• Understand that travel time to and from your site is additional to the Call-out Fee, and will be charged at a rate of $150 per hour, based on actual time travelled. We will endeavour to provide you with an estimate of the likely travel time when we contact you to discuss travel arrangements for our nominated Field Service Technician/Engineer.

• Agree that actual travel time for our nominated Field Service Technician/Engineer in attending your site will be payable by Credit Card, in accordance with the Payment Details provided by you.

I accept*