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Service Request Form

Welcome <Username>,

GenTech Scientific's well-equipped and fully staffed repair shop is available to perform expert repairs on most GC, GC/MS, LC, and LC/MS systems and accessories.

Please fill out the form below to request service. A confirmation will be sent to your email address and a technician will contact you to schedule a service call.

* Indicates a field that must be filled out.

Customer Information:

*Contact Name:	If your name is not on the list, please type your name in next line.
New Contact Name:
Shipping Address line 1:
Shipping Address line 2:
Shipping City:
Shipping State/Province:
Shipping Postal Code:
Shipping Country:
*Phone Number:
Fax Number:
*E-mail:

Service Requested:

Instrument Model 1:	GC LC GC/MS LC/MS Autosampler Other
Serial #:
Instrument Model 2:	GC LC GC/MS LC/MS Autosampler Other
Serial # 2:
Urgency Lever: High Moderate Low
In the box below, please describe problems, error messages received, and type of repair needed, if known.

Comments or Additional Model and Serial Numbers:

GenTech Scientific Service Request Form

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