PIPETTE MAIL-IN SERVICE REQUEST FORM
Print and Mail with Pipettes To:
Pipette-Tek
550M Ritchie Highway Suite 122
Severna Park, MD 21146
877.660.4600/service@pipette-tek.com

Contact:  

Lab Head:

Institution: Telephone:
Email: Fax:
Department:

Complete Return Shipping  Address (including Building & Room#): No P.O. Boxes
Purchase Order# or Credit Card Info:
Complete Billing Address:
Service Choices: ( See Service Plans for details)
Plan A            Plan B ( Includes Calibration Certificate)         Plan C ( See Service Plans for Details)
Complete any repairs necessary after inspection and return

Inspect and call with estimate before completing repairs Call only  if repairs exceed Service Plan price

  Calibration Certificate Due Date:              3 months          6 months       1 year

Specific Problems to Note:

IMPORTANT: INCLUDE SEVERAL OF YOUR TIPS FOR ACCURACY!

Method of Return Shipping: (Check One)
Priority Overnight Std Overnight 2nd Day Express SaverUPS Ground

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