Pipette repair receipt document

Please note! Transport fee, back and forth of pipettes from customer site is 70 NIS + VAT. For any faulty tested pipette, with no formal repair order, will be a charge of 100 NIS (excluding the cost of the transportation) All pipettes must be cleaned and disinfected before sending to our lab for inspection and repair.

Date

Orderer’s Name

Telephone

Company / Institution’s Name

Laboratory Name

Address

Department

Building

Floor

Room

Select quantity of pipettes (up to 4)

1 2 3 4

Model

Serial Number

The pipette has been cleaned and sterilized before sending it for treatment by

Date

Fault Description

Model

Serial Number

The pipette has been cleaned and sterilized before sending it for treatment by

Date

Fault Description

Model

Serial Number

The pipette has been cleaned and sterilized before sending it for treatment by

Date

Fault Description

Model

Serial Number

The pipette has been cleaned and sterilized before sending it for treatment by

Date

Fault Description

Please Note!

At the end of the process the form above will be sent to the email address you specified. This form must be printed and attached to the shipment

Form Details Statement

By my signature, I confirm that the pipette has been cleaned and sterilized and that all the details are correct.

Pipette repair receipt document

Pipette repair receipt document

Please Note!

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