Elliott Bay Laboratory Services
Service Request

When placing a service call remember to give as much information as possible. Telephone response time for online is two hours, depending on the time that the call was placed, at which time we will call you to schedule the date of service. Our service response time on site is 48-hours during normal business hours, however emergency service is available by calling (206) 369-6918. This form can also be printed and faxed to us at (206) 283-0537. If you would like to ship a piece of equipment to us for repair, please fill out this form and include it with your packaged equipment. Once we receive the unit we will contact you. Thank you for choosing EBLS, your business is greatly appreciated!

Service Request Form

Your Name

Person of Contact (If Different)

Company

Service Address (Where equipment is located)

Phone #

Fax #

E-mail

Billing Address (If different than service address)

Payment American Express COD Purchase Order Master Card Visa Discover

Credit Card # (If paying by CC)

Name as it appears on CC

Expiration Date (mm/yyyy)

Purchase Order #

Type of Unit

Manufacturer

Model

Serial #

Problem

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Your Name
Person of Contact (If Different)
Company
Service Address (Where equipment is located)
Phone #
Fax #
E-mail
Billing Address (If different than service address)
Payment	American Express COD Purchase Order Master Card Visa Discover
Credit Card # (If paying by CC)
Name as it appears on CC
Expiration Date (mm/yyyy)
Purchase Order #
Type of Unit
Manufacturer
Model
Serial #
Problem

Elliott Bay Laboratory ServicesService Request

Service Request Form

Elliott Bay Laboratory Services
Service Request