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Service Request Form
Contract Customers	GenTech Certified	Value Added	Training
Testimonials from Customers	Installation & Training	Service Info	Delivery
Service Request Form	Parts Department	Repair	Resource

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. Our service rate for in-shop repair is $140/hour. If you would like to contact our service staff, please contact our Service Department. Please fill out the form below to request service. A confirmation will be sent to your email address. Please print out the confirmation and send it along with your equipment to be repaired. After receiving your equipment, a GenTech Scientific Service Technician will evaluate the repairs necessary and will contact you with an estimate. The minimum charge for our evaluation service is one hour of time. All applicable taxes and freight duties are the responsibility of the customer and will be added to your invoice or billed to your shipping account. Please see Packaging Instructions before shipping. * Indicates a field that must be filled out.

Customer Information:

*Contact Name:
*Company 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:
Website

Service Requested:

Instrument Model 1:
Serial # 1:
Instrument Model 2:
Serial # 2:
In the box below, please describe problems, error messages received, and type of repair needed, if known.

Payment Information:

Promotional Code:
Payment Method:
PO Number:

Billing Address (if different from shipping address):

Address 1:
Address 2:
City:
State:
Postal Code:
Country:
Purchase Orders are subject to GenTech Scientific approval and require submission of credit references. There will be a $10 (U.S.) fee on all wire transfers.

Shipping Information:

Shipping Company:
Charge to:	Account Number:
	Prepay and Add Shipping and Handling
International customers are responsible for all customs brokering, duties, freight forwarding, and any other charges associated with shipping.

Comments or Additional Model and Serial Numbers:

Service Request Form

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