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