Sample Fillable Repair Form Page 2
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1
2* Denotes required information. Incomplete required information will delay the repair process.
Repair Options for
Pre-Approval*
Please select the corresponding number 1-7 pre-approval option for each instrument in the instrument information boxes
below. Pre-approving your repair will reduce the turnaround time by 2-3 days.
1
2
Up to $500.00 (Default) Per Instrument
1
Up to $1,000.00 Per Instrument
4
3
Up to $1,500.00 Per Instrument
Up to $2,000.00 Per Instrument
5
6
Up to $2,500.00 Per Instrument
Pre-Approved / No Estimate Required
7
Estimate Required
1, 2
($125.00 estimate fee per instrument charged, fee waived if estimate approved)
Instrument
Information*
Instrument
Information*
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Model:
Model:
Serial Number:
Serial Number:
Detailed description of problem:
Detailed description of problem:
Expedite this repair
3
Expedite this repair
3
Instrument
Information*
Instrument
Information*
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Model:
Model:
Serial Number:
Serial Number:
Detailed description of problem:
Detailed description of problem:
3
3
Expedite this repair
Expedite this repair
1
No estimate will be provided for repairs less than $500.00 per instrument by default, unless Estimate Required selection is made above. No charges
will be due if it is determined to be a warranty repair.
2
Instrument repair estimates not approved after 30 days will be charged 1hr labor and returned unrepaired.
3
FOR EXPEDITED REPAIRS ONLY: There will be an additional $200.00 charge and you must select one of the pre-approved options above.
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