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Service Preference*

*Although there is no minimum for Off-Site (Ship-In) service, we do have a minimum to qualify for On-Site Service.

First Name*

Last Name*

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Company*

Department

Number of Single Channel Pipettes

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Number of Multi Channel Pipettes

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Service Level:*

Research Level*

Clinical Level*

Regulated Level*

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Number of 8-Channel Pipettes*

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Number of 12-Channel Pipettes*

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Date by which you need initial service completed:

*NOTE: Expedited Ship-In Service is an additional cost, and will be approved based on availability.

Notes

Equipment List

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Additional Equipment Services

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Number of Balances (Analytical or Top-Loader)

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Number of Thermometers, Temperature Probes

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Number of High-Throughput Liquid Handlers

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Number of Thermocylers

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Number of Timers

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Number of Centrifuges

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Number of Syringe Pumps

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Number of pH Meters

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Number of Conductivity Meters

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Number of Weight Sets

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Number of Air Flow Sensors

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Number of Autoclaves

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Number of Hygrometers

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Number of Microscopes

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Number of Fume Hoods

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Number of Humidity Chambers

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Recurring Maintenance Schedule

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Equipment Service Interval

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Additional Equipment Services

Recurring Maintenance Schedule