SERVICE REQUEST FORM (USA) Please complete all fields below and we will provide you with a quotation for our services: Instrument DetailsInstrument Make(Required)Please choose from the list below:Astori TecnicaAqualabCEMDKK-TOAMatrix InstrumentsOPSIS LiquidlineInstrument Model(Required)Please choose from the list below:CryoTouch 1CryoTouch 20CryoTouch 40OsmoTouch 1OsmoTouch 20OsmoTouch 40CryoSmart 1CryoSmart 20CryoSmart 40Instrument Model(Required)Please choose from the list below:PawkitPreSeries 3 (White box)Series 3 (Black Box) - Cleaning/Verification onlySeries 4TESeries 4TEVSeries 4 (non-TE/TEV)TDL/TDL2Instrument Model(Required)Please choose from the list below:Labwave 9000Smart 5/TurboSmart 6Smart Trac/Smart Trac IIInstrument Model(Required)SAT-500 Chloride AnalyzerInstrument Model(Required)MOJO-60Instrument Model(Required)Please choose from the list below:KJELROC DISTILLER/ANALYZER/AUTOSAMPLERKJELROC DIGESTOR/SCRUBBERSOXROC EXTRACTORFIBERROCSerial Number(Required)Password (if protected):Services RequestedPlease select the services you require...(Required) Calibration Repair Preventive Maintenance Desired Service Level:(Required) Standard Express Standard service is first come, first served. Express service places your instrument at the front of the line (additional fee applies)Do you need a rental instrument?(Required) Yes No Rental Period(Required) 2 Weeks 1 month Give a brief summary of any issues:(Required)Company InformationCompany Name(Required)Contact Name(Required) First Last Email(Required) PhoneExt.Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code LogisticsWhich office will you be sending your instrument to?(Required) Massena, NY Client Location (On-Site) Return Shipping Information(Required) Use the courier account on file with Meyer Service & Supply Ltd I will provide my courier information I do not have a courier account, add the shipping charges to my invoice Courier Name(Required)Courier Account Number:(Required)Purchase Order NumberMaximum PO AmountPurchase Order Upload (optional): Drop files here or Select files Max. file size: 8 MB, Max. files: 3.
