Service Request Form

Name _____________________________________________

Company___________________________________________

Address____________________________________________

City_____________________ State ________  Zip__________

Phone ___________________  Fax ______________________

Manufacturer/Model _________________Serial #____________

Service Required_____________________________________

___________________________________________________

ESTIMATE:  Prior to repair, we will fax a written estimate of all costs to repair instrument(s).  A per instrument service fee applies to all rejected estimates.


NEW ACCOUNTS:
  We require 1-bank and 3-trade references to set-up new account.


WE ACCEPT VISA, MASTERCARD, & AMERICAN EXPRESS.

 

2 Locations:

Safety Instruments 247 Route 100 (Suite 2004) Somers New York 10589
Toll Free PH: 877-832-4737

Detect Services 1318 Underwood Ave. (Suite 101) LaPorte TX. 77571
Toll Fee PH: 877-500-2706


Instructions: When returning items for repair or calibration please print and fill out his form.  Return this form with the item(s) to one of our 2 locations.  We will provide a written estimate prior to performing any repair.  Please call us at one of our Toll Free Locations for assistance. 
New York Location Toll Free 877-832-4737 / Texas Location Toll Free 877-500-2706