SERVICE REQUEST FORM
Should it become necessary to have your MSE centrifuge repaired, please take a few
moments to fill out this form, which will help us to ensure you receive the best and fastest
service possible.
Model:
...........................................................................
Serial number:
(on plate at back of unit)
...........................................................................
Date purchased:
...........................................................................
Where purchased:
...........................................................................
Brief description of fault:
...........................................................................
...........................................................................
...........................................................................
Date fault first occurred:
...........................................................................
Date repair centre contacted:
...........................................................................
Authorisation number:
...........................................................................
Condition of centrifuge:
...........................................................................
Has it been disinfected?
Yes / No
Disinfectant used:
...........................................................................
Contact name:
...........................................................................
Address:
...........................................................................
...........................................................................
...........................................................................
Telephone Number:
...........................................................................
Signature: .........................................................................................................................
