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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Distributor Name

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(If want information on terms, check box) Invalid Input

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.

Invalid Input

PMCAL Invalid Input

4.

Invalid Input

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 the submit button I'll be added to the Caron Scientific mailing list. To submit this form, you must provide consent for your information to be stored. Alternatively, you may contact us by emailing info@caronproducts.com directly.

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

PCR

Laminar Flow

Biosafety

Operator Protection

Product Protection

Operator & Product Protection

Service Request Form

Fields Marked * are required for processing

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