"ON-SITE" Service Request

Please fill out and submit the "ON-SITE" Services Request Form below to schedule service at your facility. A Calibrate Representative will contact you within 24 hours to schedule the service and make all necessary arrangements. Our Canadian customers can now order services online for immediate service as well.

* = Required Field

On-Site Service Request Form:
* First Name:	* Last Name:
Job Title:	* Email:
* Telephone:	Fax:
* Institution:	Department:
Bldg/Room No.:	Campus Box:
* Street Address:	* City:
* State: Alaska Alabama Arkansas Arizona California Colorado Connecticut Washington D.C. Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming	* Zip:
* Country: United States	Cell Phone:
Servicing Requirements:
* Please select your service level: Please select the appropriate service level for your facility's requirements. For information about our 6 levels of service click here. Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 N/A
* Please select your Preferred Calibration Interval: 30 days 90 days 180 days 360 days Other
* Restrictions: Only necessary for Levels 3-6. GLP cGMP Other NA
Service Provided:
Indicate How Many Pipettes Are In Need Of Service?
If not requesting service for a particular style, please enter a '0' (zero) in that quantity field.
* Single Channel Pipettes:	* Multi Channel Pipettes:
Payment Methods:
Select a Payment Method:	Pay With Credit Card Purchase Order Other
Creating an account:
You will use the following EMAIL and password to log into the site for all future requests.
* Login	* Password Confirm your password by typing it again:
Please enter this code before submitting. This will help reduce the amount of SPAM we receive from programs that automatically complete these types of forms. Thank you.