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Instrument Repair Form

Return Address
Name (first/last)
Email
Company
Street Address
City
State
Zip
Phone
Fax
Shipping Method
Federal Express
U.S. Postal
RPS
UPS
Check if Billing Address is the same as Return Address above. Billing Information
Name (first/last)
Email
Company
Street Address
City
State
Zip
Phone
Fax
Contact Person for Approval
PO Number (optional)
Instrument Information
Manufacturer
Model Number
Serial Number
Brief Description of the Problem
Type of Service Requested
Warranty Repair (Please provide proof of purchase)
24 Hour Service (One working day - $150)
72 hr Service (Three working days - $100)
Standard Service (Done in order of receipt - $60)