Service Request Form

Company name & physical address of the equipment requiring service:

Company Name*

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Physical Address of Equipment *

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Bill to Address (If different):

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Tax Exempt*

Yes (If yes, please email tax exempt certificate to service@caronproducts.com)No Invalid Input

End user’s name, email and phone number for scheduling on site contact:

Name*

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Email*

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Phone Number*

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Best method for communication with end user while on site:

PhoneEmail Invalid Input

Select one of the following*

Distributor Quote

Direct NET30 with Caron

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Serial numbers of chambers, incubators and water recirculators that require service:

Number of units requiring service?*

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1.

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PM

CAL

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2.

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PMCAL Invalid Input

3.

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PMCAL Invalid Input

4.

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PMCAL Invalid Input

5.

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PMCAL Invalid Input

Serial numbers and bulb hours of photostability chambers that require service:

Serial #1

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PMCAL Invalid Input

UVA Bulb Hours

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VIS Bulb Hours

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Serial #2

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PMCAL Invalid Input

UVA Bulb Hours

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VIS Bulb Hours

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Serial #3

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PMCAL Invalid Input

UVA Bulb Hours

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VIS Bulb Hours

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Are there any issues with the equipment we need to be prepared for? If so, note serial number with description of issues:

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Is on site training required?

NoYes Invalid Input

How long is training?

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Is training offered at specific times?

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Special Instructions:

Parking Requirements? If so, note details:

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Badge Requirements? If so, note details:

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Covid Vaccination Required:

YesNo Invalid Input

Covid Company Policy:

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How did you find the Online Service Request Form?*

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I acknowledge that by clicking submit I am opting into your mailing list.

Stability /Environmental

Heated/Humidified

Freeze/Thaw

Photostability

Refrigerated

Plant Growth

Insect Rearing

Animal Rearing

Refrigerated

Stackable CO2

Heated/Humidified

Reach-In CO2

Baths/Circulators

Condensate Recirculating System

Ductless Fume

Laminar Flow

Application Specific

Powder Weighing

Storage

Laminar Flow

Biosafety

Operator Protection

Product Protection

Operator & Product Protection

Service Request Form

Fields Marked * are required for processing

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