RADCAL  DYNALYZER  SERVICE  REQUEST  FORM


Purchase Order #: 
   
( Amount according to Radcal Price List )

BILL  TO:

Mr.  Ms  Dr. 
First Name Last Name
Company/Hospital Department
Address City
State/County    Zip/Postal Code
Country 
Phone  Fax 
Email 

SHIP  TO:

Click HERE if same as "Bill To"

Mr.  Ms  Dr. 
First Name Last Name
Company/Hospital Department
Address City
State/County    Zip/Postal Code
Country 
Phone  Fax 
Email 


Shipping company preferred and method of shipment:


Providing the following data about the equipment and whom we may contact for additional technical details will greatly assist Radcal in servicing your instrument.

Technical Contact  
Phone    Email 

Instrument Description 
Serial Number 

Normally we test, repair if necessary, and calibrate each instrument we receive. 
Please check the appropriate box.
 
Repair and Calibrate Calibrate Only Call if repairs are requested Upgrade

 

Please note any functions where you have had problems.

Function No Output Intermittent Noisy Expected Actual
Anode Voltage  
( Dynalyzer, HV-1 ) 
Cathode Voltage  
( Dynalyzer, HV-1 )
Anode mA  
( Dynalyzer only )
Filament Current  
( Dynalyzer only )

Notes:
 

 


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