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Vaporizer Service Information Request

 

For vaporizer repair/service pricing and shipping infomation, please
complete this form for each vaporizer on which you need information.

Vaporizer make and model: 1   Qty 
2   Qty 
3   Qty 


Are any vaporizers damaged or in need of more than routine servicing?
If so, please explain:


Name

Hospital
Address
City
State
Zip
Phone
E-mail

General information:
Most service and repairs are completed overnight at no additional charge.
Vaporizers are normally shipped UPS ground. Do you want overnight shipping at extra charge? No Yes
Billing: An invoice will be sent with your vaporizers when the work is completed.
Government and other institutions: Please include a purchase order with your shipment.

Thank you. The information you have requested will be sent to you as soon as possible.

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