SERVICE REQUEST FORM Please complete all fields below: Instrument DetailsInstrument Make(Required)Choose from the list below:Astori TecnicaAqualabBentleyCEMDansensorDKK-TOAMatrix InstrumentsMoconOPSIS LiquidlineInstrument Model(Required)Choose from the list below:CryoTouch 1CryoTouch 20CryoTouch 40OsmoTouch 1OsmoTouch 20OsmoTouch 40CryoSmart 1CryoSmart 20CryoSmart 40Instrument Model(Required)Choose from the list below:Series 3 (White box)Series 4TESeries 4TEVSeries 4 (non-TE/TEV)PawkitSeries 3 (Black Box) - Cleaning/Verification onlyInstrument Model(Required)Choose from the list below:DairySpec FTSomaCount FCBactoCount IBCFTS/FCM CombiBentley 150/2000 IRInstrument Model(Required)Choose from the list below:Labwave 9000Smart 5/TurboSmart 6Smart Trac/Smart Trac IIInstrument Model(Required)Choose from the list below:CheckMate 3CheckMate 4CheckPoint 3CheckPoint 4ISM-3LeakPointer IILeakPointer 3LeakPointer H2OLippke 4000Lippke 4500Lippke 5000Lippke VC1380Lippke VC1400MAP Check 3 O2MAP Check 3 O2/CO2MAP Mix 9001MAP Mix FocusMAP Mix ProvectusMultiCheck 2Other (see below)My Dansensor:Instrument Model(Required)SAT-500 Chloride AnalyzerInstrument Model(Required)Choose from the list below:AQUATRAN SERIESOPTECH O2/MODEL POX-TRAN SERIESPAC CHECK 302/325PAC CHECK 333PAC CHECK 450/650PAC CHECK 800 SERIESPERMATRAN-W SERIESPERMATRAN-C SERIESIf you don't see your gas analyzer here, check with Dansensor as the Instrument MakeInstrument Model(Required)MOJO-60Instrument Model(Required)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 (additional fee) Do you need a rental instrument?(Required) Yes No Rental Period(Required) 2 Weeks 1 month Give a brief summary of any issues: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) Burnaby, BC Hamilton, ON Long Sault, ON Client Location (On-Site) Which office will you be sending your instrument to?(Required) Long Sault, ON (For Pac Check 333 & OpTech models)Which office will you be sending your instrument to?(Required) Hamilton, ON For Mocon PAC Check (non-333)Return Shipping Information(Required) Use the courier account on file with Meyer Service & Supply Ltd I will provide my courier information Please prepay and 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.
