Equipment Service Request

Complete ENTIRE FORM below. We will contact you with a quote and an estimated turnaround time. To expedite service, pre-authorize your repairs up to a specified dollar amount. For assistance, please contact us at (412)281-4186 or via email: [email protected] . We are unable to initiate a repair without a Purchase Order number. If a return shipping account number is not provided on this form, the cost of shipping will be added to your final invoice. Payment is NET 30 unless otherwise specified.

Service Request Form

Please fill out the form below in order to submit an item for valuation.

Ship To:

(Contact Person Regarding Repair)

Bill To:

Your Contact Information:

Submit

REMINDER: PURCHASE ORDER NUMBER MUST BE PROVIDED WITH THIS FORM

Ship Equipment Including Form To:

SPS Repair 2340 Stock Creek Blvd. Rockford, TN 37853

Phone: 412-281-4186 Fax: 412-774-2345

[email protected]

Thank you for choosing Surgical Product Solutions. Ask us about our Repair/Exchange Program!