RADCAL  CALIBRATION / REPAIR  REQUEST  FORM

Purchase Order #: Not to exceed amount:
( 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:
 
Technical Contact: 
Phone    Email 
 

Product
Serial Number
Warranty Extension
Certified Calibration
Certificate of Conformance
Repair

Problem(s) Experienced

Certified Calibration Points Desired


Radcal terms are Net 30 and FOB is Monrovia.
Please send copy of your Purchase Order with Shipment.

EXPEDITE  SERVICES
Radcal contact   Date 
To contact Radcal Calibration and Repair Services call:  (626) 357 - 7921  ext. 16.

The above information must be provided to comply with the 5 day guarantee.

 


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