SERVICE REQUEST FORM
Should it become necessary to have your MSE centrifuge repaired, please take a few
moments to fill out this form, which will help us to ensure you receive the best and fastest
service possible.
Model:
...........................................................................
Serial number:
(on plate at back of unit)
...........................................................................
Date purchased: ...........................................................................
Where purchased: ...........................................................................
Brief description of fault: ...........................................................................
...........................................................................
...........................................................................
Date fault first occurred: ...........................................................................
Date repair centre contacted: ...........................................................................
Authorisation number: ...........................................................................
Condition of centrifuge: ...........................................................................
Has it been disinfected? Yes / No
Disinfectant used: ...........................................................................
Contact name: ...........................................................................
Address: ...........................................................................
...........................................................................
...........................................................................
Telephone Number: ...........................................................................
Signature: .........................................................................................................................
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