Something Kevin wrote in 2004 for prospective clients.
I think we might have used this, but I don’t remember for sure.

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Service Questionnaire

Today’s Date:

Name
Address (make a box for them to enter it instead of the usual fields.)
Shipping address (if different from above)

Phone number
Email

Unit: Make/Model
Serial Number
How long have you owned this unit?

Intended usage of instrument (choose from the following):
Professional Recording
Professional Touring
Home use
Storage
Sale/Trade
Consignment (click here for more details)

I intend to use this instrument
Every Day
Weekly
Monthly
I don’t intend to play this instrument for a long period of time.

Can you rate these on order of importance to you? (1 least – 10 most)
A. Cosmetics
B. Tuning accuracy
C. Reliability
D. Hi fidelity/ low CV offsets (opamp and other improvements)
E. Cost of services
F. Turnaround time
G. Originality (meaning “without modification”)

What environment is this synth likely to see (check all that apply)?

Humidity
High temperatures
Dry air
Dust
Ocean air
High altitude

Keyboard functionality and feel are:
Supremely important
Moderately important
Not a major concern
I do not intend on playing the keyboard

Performance controls (benders, wheels, levers, etc) functionality and feel are:
Supremely important
Moderately important
Not a major concern
I do not intend on using the performance controls

Interface jacks functionality and feel are:
Supremely important
Moderately important
Not a major concern
I do not intend on interfacing this unit.

I would like this unit to be:
Restored to the highest detail
Restored to a reasonable degree
Kept as stock as possible
Repaired per our discretion
Serviced as minimally as possible

I want to be informed:
Of any possible questions and concerns
If the unit exceeds $___ (add field to enter amount)
Only when the unit is completed
Of expected delays

I can provide a deposit with the unit (Yes/No)

I have read your FAQ and shipping guidelines page (Yes/No)

Will you need shipping materials sent to you?

Please list the type of music you will be using this unit for:
Electronica
Jazz
Rock
Classical
World
Group Performance
Other

What type of amplification system do you intend to use? (text field)

Would you like a private directory on synthfool.com to see pictures of your synth in progress?

Would you prefer an update on a regular basis
Weekly
Monthly

This information will accompany your synth while it is being serviced. If you have any additional comments, instructions, or concerns, please list them below: