Request a Service

To request a Convergent service please complete the form below. A service representative will respond promptly.

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Service Type
Service
Your Details
First Name:
Last Name:
Phone Number:
Email:
Primary Site Contact
First Name:
Last Name:
Phone:
Mobile:
Alternate Site Contact
First Name:
Last Name:
Phone:
Mobile:

Order Details
Purchase Order Number:
Help Desk Request Number:
Company Name:
Site Address:

Equipment
Type:
Brand:
Model:
Serial No:
Asset No:
Description of Fault / Comments:
If this is the first time that you have used us, please tell us how you heard about us.
service@conres.net.au

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